Jill Lynette Davis

Key facts

NPI

1366072753

Entity type

Individual (NPI type 1)

Primary specialty

Registered Nurse 163W00000X

License

R1314931 (MN)

Practice address

22 Dayton Ave SE
Wadena, MN 56482-1526

Phone

(218) 631-7629

NPI assigned

Jan 24, 2020

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of Wadena Public Health or Welfare Agency · Wadena, MN · NPI 1679576912
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 24, 2020.

{
    "created_epoch": "1579824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1366072753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 DAYTON AVE SE",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564821526",
            "telephone_number": "218-631-7629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 DAYTON AVE SE",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564821526",
            "telephone_number": "218-631-7629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JILL",
        "middle_name": "LYNETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-24",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "R1314931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "copublichealth@co.wadena.mn.us",
            "affiliation": "N",
            "address_1": "22 Dayton Ave SE",
            "city": "Wadena",
            "state": "MN",
            "country_code": "US",
            "postal_code": "564821526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wadena, MN

• Community Behavioral Health Hospital-Wadena
• County of Wadena
• Charity Joy-Klebs Crosby, CMII
• Meghan Current-Cary, SLP
• Dawn Dahlgren-Roemmich, CNM
• Robert P. Davis, PA-C
• Stephen E Davis, MD
• Miriam A Decock, CHNP, PT
• Vickie L Dennis, MD
• Sulma Disselbrett, RN

All providers in Wadena, MN · Registered Nurse in Minnesota