Provider Demographics
NPI:1407847551
Name:THILL, DEBRA J (CPNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:THILL
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:1900 CENTRA CARE CIR #1300
Mailing Address - Street 2:CENTRA CARE CLINIC WOMEN'S & CHILDREN'S
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3610
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRA CARE CIR #1300
Practice Address - Street 2:CENTRA CARE CLINIC WOMEN'S & CHILDREN'S
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3610
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR-095701-4363LP0200X
MNR095701-4363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
136613100OtherMEDICAL ASSISTANCE
06-28-04OtherCHAMPUS
267L3BEOtherBLUE CROSS BLUE SHIELD
HP31039OtherHEALTH PARTNERS
2172435OtherARAZ GROUP AMERICAS PPO
7-22-04OtherMMSI
1025652OtherPREFERRED ONE
6-28-04OtherONEHEALTH PLAN/GREAT WEST
1202912OtherMEDICA HEALTH PLANS
151365OtherU-CARE
6-28-04OtherFIRST HEALTH PLAN
500002704Medicare PIN
06-28-04OtherCHAMPUS