Provider Demographics
NPI:1376788968
Name:LYLE, JILL NICOLE (CNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:NICOLE
Last Name:LYLE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:NICOLE
Other - Last Name:BAERTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-9000
Mailing Address - Fax:
Practice Address - Street 1:2833 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1319
Practice Address - Country:US
Practice Address - Phone:612-863-3333
Practice Address - Fax:763-577-7800
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP27363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner