Healthcare Provider Details

I. General information

NPI: 1922513100
Provider Name (Legal Business Name): JILL M DAVID JENSEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL M JENSEN NP

II. Dates (important events)

Enumeration Date: 12/09/2017
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

IV. Provider business mailing address

612 S SIBLEY AVE
LITCHFIELD MN
55355-3340
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-1670
  • Fax:
Mailing address:
  • Phone: 320-693-4528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5687
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN201511-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: