Provider Demographics
NPI:1649432204
Name:AMSBERRY, JILL LYNN (DO)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:LYNN
Last Name:AMSBERRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:LYNN
Other - Last Name:CHRISTIANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR #1300
Mailing Address - Street 2:CENTRACARE CLINIC WOMEN'S & CHILDREN'S
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3610
Mailing Address - Fax:
Practice Address - Street 1:1900 CENTRACARE CIR #1300
Practice Address - Street 2:CENTRACARE CLINIC WOMEN'S & CHILDREN'S
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-8471208000000X
MN105398208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics