Healthcare Provider Details

I. General information

NPI: 1174497267
Provider Name (Legal Business Name): JILL MULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

607 MAIN ST
BROWNSVILLE MN
55919-5001
US

V. Phone/Fax

Practice location:
  • Phone: 612-725-2000
  • Fax:
Mailing address:
  • Phone: 507-458-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number38957
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: