Individual
JILL LYNETTE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22 DAYTON AVE SE, WADENA, MN 56482-1526
(218) 631-7629
Mailing address
22 DAYTON AVE SE, WADENA, MN 56482-1526
(218) 631-7629
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R1314931
MN
Other
Enumeration date
01/24/2020
Last updated
01/24/2020
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