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NPI Code Detail

MEDICARE: JILL NICOLE LYLE CNP

MEDICARE: JILL NICOLE LYLE CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerCNP27MN

General Provider Information

NPI Number : 1376788968
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL NICOLE LYLE CNP
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-9000
Fax Number :
Provider Business Practice Location Address
First Line : 2833 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1319
Country : US
Telephone Number : 612-863-3333
Fax Number : 763-577-7800
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2008
Last Update Date : 08/29/2023

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