Provider Demographics
NPI:1225376890
Name:NEDVED, JILLIAN RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RAE
Last Name:NEDVED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:KRCIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 4TH AVE SW
Mailing Address - Street 2:STE 210
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1455
Mailing Address - Country:US
Mailing Address - Phone:507-825-7340
Mailing Address - Fax:507-825-7344
Practice Address - Street 1:414 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-4810
Practice Address - Country:US
Practice Address - Phone:605-271-2200
Practice Address - Fax:605-271-2798
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2389363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant