MEDICARE: JILL RENEE GOVEN FNP

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	363L00000X	Nurse Practitioner	R25966	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24014	OTHER	ND	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	24011	OTHER	ND	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	23642	OTHER	ND	BCBS
8	23643	OTHER	ND	BCBS
9	1770591927	OTHER	ND	COMMERICAL INSURANCE

General Provider Information

NPI Number	:	1780776559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL RENEE GOVEN FNP

Provider Business Mailing Address
First Line	:	PO BOX 253
Second Line	:
City	:	UNDERWOOD
State	:	ND
Zip	:	58576-0253
Country	:	US
Telephone Number	:	701-442-3148
Fax Number	:	888-306-1159

Provider Business Practice Location Address
First Line	:	1167 BORDER LN
Second Line	:
City	:	WASHBURN
State	:	ND
Zip	:	58577-4102
Country	:	US
Telephone Number	:	701-462-3389
Fax Number	:	888-306-1159

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	01/03/2020

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