Individual
JILL MARIE ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102
(320) 234-2000
(320) 685-4020
Mailing address
PO BOX 2010, FARGO, ND 58122-2484
(320) 234-1230
(320) 685-4020
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R45818
ND
363LF0000X
Family Nurse Practitioner
2008004407
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221637000
—
MN
Enumeration date
07/07/2008
Last updated
07/05/2018
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