1801893250 NPI number — MS. JILL MARIAN KONFRST ARNP

Table of content: MS. JILL MARIAN KONFRST ARNP (NPI 1801893250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801893250 NPI number — MS. JILL MARIAN KONFRST ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONFRST
Provider First Name:
JILL
Provider Middle Name:
MARIAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801893250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 43
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55440-0043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-262-1166
Provider Business Mailing Address Fax Number:
612-262-4258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 E OSKALOOSA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PELLA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50219-2208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-780-0743
Provider Business Practice Location Address Fax Number:
641-204-0218
Provider Enumeration Date:
06/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  A076744 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)