Healthcare Provider Details

I. General information

NPI: 1386578102
Provider Name (Legal Business Name): JILL MARIE ROSENTHAL BSN, RN, PHN, LSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 11TH AVE SE
FOREST LAKE MN
55025-1823
US

IV. Provider business mailing address

246 11TH AVE SE
FOREST LAKE MN
55025-1823
US

V. Phone/Fax

Practice location:
  • Phone: 651-252-6740
  • Fax:
Mailing address:
  • Phone: 651-252-6740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1605349
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: