Provider Demographics
NPI:1619007911
Name:GASSEN, JILL MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:GASSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:KURTENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1106 E CLARK ST
Mailing Address - Street 2:APT 24
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-2620
Mailing Address - Country:US
Mailing Address - Phone:605-670-0309
Mailing Address - Fax:
Practice Address - Street 1:2501 W 22ND STREET
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57117-5046
Practice Address - Country:US
Practice Address - Phone:605-333-6852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical