Provider Demographics
NPI:1750367280
Name:CHAO, JILL LORRAINE (CNM)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:LORRAINE
Last Name:CHAO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-1601
Mailing Address - Country:US
Mailing Address - Phone:507-437-0036
Mailing Address - Fax:507-437-0036
Practice Address - Street 1:1305 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1601
Practice Address - Country:US
Practice Address - Phone:507-437-0036
Practice Address - Fax:507-437-0036
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8450367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN420000261OtherMEDICARE RAILROAD
MNS31525Medicare UPIN
MN420000325Medicare ID - Type Unspecified
MN771423800Medicare ID - Type Unspecified