Provider Demographics
NPI:1548236292
Name:WILLETT, JANE K (DO)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:K
Last Name:WILLETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1420 E COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2065
Mailing Address - Country:US
Mailing Address - Phone:507-532-9631
Mailing Address - Fax:507-532-1176
Practice Address - Street 1:1420 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2065
Practice Address - Country:US
Practice Address - Phone:507-532-9631
Practice Address - Fax:507-532-1176
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN34361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN580868500Medicaid
E96700Medicare UPIN
MN580868500Medicaid