Provider Demographics
NPI:1225349780
Name:GORING, JILL MARIE (RN, CNS)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:GORING
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:REGGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:640 JACKSON ST
Mailing Address - Street 2:MAIL STOP: 11503G
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2502
Mailing Address - Country:US
Mailing Address - Phone:651-254-3632
Mailing Address - Fax:651-254-3123
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:MAIL STOP: 11503G
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3632
Practice Address - Fax:651-254-3123
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 152948-3364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health