Provider Demographics
NPI:1821642364
Name:DORN, JILL SHANNON (DNP/FNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SHANNON
Last Name:DORN
Suffix:
Gender:F
Credentials:DNP/FNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:SHANNON
Other - Last Name:FLABY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP/FNP
Mailing Address - Street 1:200 FIRST STREET SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 FIRST STREET SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6835363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner