Healthcare Provider Details

I. General information

NPI: 1225261902
Provider Name (Legal Business Name): JILL ELIZABETH KUYAVA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 EXCELSIOR BLVD
ST LOUIS PARK MN
55416-2913
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-1000
  • Fax: 952-993-1160
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1793
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: