Individual
JILL L WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2800 CLEVELAND AVE N, ROSEVILLE, MN 55113-1126
(651) 642-1825
Mailing address
10068 MAPLEWOOD CIR N, CHAMPLIN, MN 55316-3146
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R1073036
MN
Other
Enumeration date
06/22/2007
Last updated
07/08/2007
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