Provider Demographics
NPI:1427042019
Name:ENGLUND, JILL MARIE (PAC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:ENGLUND
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 DUPONT AVE SO
Mailing Address - Street 2:SUITE 425
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3100
Mailing Address - Country:US
Mailing Address - Phone:952-888-5800
Mailing Address - Fax:
Practice Address - Street 1:9801 DUPONT AVE SO
Practice Address - Street 2:SUITE 425
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3100
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9928OtherSTATE LICENSE
MN9928OtherSTATE LICENSE