MEDICARE: MS. JILL DAWN MCGILL

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
1	171W00000X	Contractor	1057518-2-AFC	MN

General Provider Information

NPI Number	:	1750656518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL DAWN MCGILL

Provider Business Mailing Address
First Line	:	5898 S ROBERT TRL
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55077-1414
Country	:	US
Telephone Number	:	651-450-5965
Fax Number	:

Provider Business Practice Location Address
First Line	:	5898 S ROBERT TRL
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55077-1414
Country	:	US
Telephone Number	:	651-450-5965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	03/13/2012

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