Provider Demographics
NPI:1174893879
Name:MCMULLEN, JILL (DNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 56TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6706
Mailing Address - Country:US
Mailing Address - Phone:701-356-1500
Mailing Address - Fax:701-356-1596
Practice Address - Street 1:3800 56TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6706
Practice Address - Country:US
Practice Address - Phone:701-356-1500
Practice Address - Fax:701-356-1596
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7756363LP0808X, 363LF0000X
ND31131363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health