Provider Demographics
NPI:1821376849
Name:TRILL, JODIE LOUISE (RN)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:LOUISE
Last Name:TRILL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E MINNESOTA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1666
Mailing Address - Country:US
Mailing Address - Phone:320-634-5720
Mailing Address - Fax:320-634-0159
Practice Address - Street 1:211 E MINNESOTA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1666
Practice Address - Country:US
Practice Address - Phone:320-634-5720
Practice Address - Fax:320-634-0159
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 95514-2163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse