Provider Demographics
NPI:1881890754
Name:HANSEN, JILL S (NP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:HANSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057
Mailing Address - Country:US
Mailing Address - Phone:507-646-1000
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:706 DIVISION ST S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057
Practice Address - Country:US
Practice Address - Phone:507-646-6700
Practice Address - Fax:206-781-6285
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007717363LF0000X
MN5921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8869134Medicare UPIN