JILL M HENNESSY (NPI# 1932126893) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932126893 |
| Entity Type | Individual |
| Full Name | JILL M HENNESSY |
| Credential | PA-C |
| Practice Address |
737 Broadway Fargo ND 58122-0001 |
| Mailing Address |
801 Broadway N Fargo ND 58102-3641 |
| Practice Telephone | 7012343360 |
| Practice Fax Number | 7012343868 |
| Mailing Telephone | 7012343360 |
| Mailing Fax Number | 7012343868 |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2012-10-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PAC0286 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
9818 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 71064 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861485922 | Jill Marie Hennessy | Pathology | 2001 Webber St, Sarasota, FL 34239-5288 | 2005-08-24 |
| Street Address |
737 BROADWAY |
| City | FARGO |
| State | ND |
| Zip Code | 58122-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437103959 | Robin J Sickels | Dietitian, Registered | 737 Broadway, Fargo, ND 58122-0001 | 2006-05-20 |
| 1679883680 | Summer Schauer | Nurse Anesthetist, Certified Registered | 737 Broadway, Fargo, ND 58122-0001 | 2010-10-13 |
| 1588974596 | Melissa Vanmatre | Nurse Anesthetist, Certified Registered | 737 Broadway, Fargo, ND 58122-0001 | 2010-10-13 |
| 1164652640 | Sanford Clinic North | Clinical Medical Laboratory | 737 Broadway, Fargo, ND 58122-0045 | 2009-07-20 |
| 1710138375 | Kent C Moser | Nurse Anesthetist, Certified Registered | 737 Broadway, Fargo, ND 58122-0001 | 2008-10-01 |
| 1023268711 | Katie C Busker | Nurse Anesthetist, Certified Registered | 737 Broadway, Fargo, ND 58122 | 2008-09-30 |
| 1770731473 | Andrea B Peterson | Nurse Practitioner | 737 Broadway, Fargo, ND 58122-0001 | 2008-09-05 |
| 1801091384 | Vijay Korimilli | Internal Medicine | 737 Broadway, Fargo, ND 58122-0001 | 2007-06-15 |
| 1437362571 | Heidi J Lako-adamson | Emergency Medicine | 737 Broadway, Fargo, ND 58122-0001 | 2007-05-07 |
| 1164567970 | Kristen M Liebl | Dietary Manager | 737 Broadway, Fargo, ND 58122-0001 | 2007-02-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184142747 | Kayla Estepp | Internal Medicine | 737 Broadway North, Fargo, ND 58122 | 2017-09-05 |
| 1376091793 | Paul Mckay | Physical Therapist | 801 Broadway N., Fargo, ND 58122 | 2016-09-14 |
| 1801290150 | Mark Noah | Physical Therapist | 1720 South University, Fargo, ND 58122 | 2014-10-15 |
| 1245633486 | Diana Palm | Physical Therapist | 1720 University Drive South, Fargo, ND 58122 | 2014-10-02 |
| 1447696406 | Mohamad Imam | Internal Medicine | 801 Broadway North, Fargo, ND 58122 | 2013-05-17 |
| 1457615155 | Chantee Seung Gruenhagen | Nurse Practitioner | 737 North Broadway, Sanford Urology Clinic, Fargo, ND 58122 | 2012-06-27 |
| 1457594079 | Manisha Balhara | Specialist | 2400 32nd Avenue S, Fargo, ND 58122 | 2009-04-13 |
| 1578536728 | Shelby A Terstriep | Internal Medicine | 820 4 Street North, Fargo, NC 58122 | 2006-02-08 |
| 1295229946 | Christopher Hinh | Student in an Organized Health Care Education/Training Program | 801 Broadway North, Fargo, ND 58122 | 2018-06-17 |
| 1558854539 | Suchita Kotnala | Family Medicine | 737 Broadway North, Fargo, ND 58122 | 2018-06-13 |
| Find all providers in zip 58122 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205015633 | Jamie M Brown | Physician Assistant | 1711 Gold Dr S, Suite 170, Fargo, ND 58103-6416 | 2007-11-02 |
| 1790703353 | Mary Jane Kadry | Physician Assistant | 1121 Westrac Dr S Ste 204, Fargo, ND 58103-2385 | 2006-07-18 |
| 1861419723 | Catherine M Garvey | Physician Assistant | 2801 University Dr S, Fargo, ND 58103-6029 | 2006-07-16 |
| 1881148005 | Kali Luecke | Physician Assistant | 301 Np Ave N, Fargo, ND 58102-4835 | 2016-08-04 |
| 1215480009 | Jason Byrne Smith | Physician Assistant | 801 Broadway N, Fargo, ND 58102-3641 | 2016-07-27 |
| 1659758381 | Sarah Winter | Physician Assistant | 1702 University Dr S, Fargo, ND 58103-4940 | 2015-05-01 |
| 1861801763 | Lisa Lynn Froemke | Physician Assistant | 3838 12th Ave N, Fargo, ND 58102-2931 | 2014-08-05 |
| 1033525365 | Kathryn Gray | Physician Assistant | 301 Np Ave N, Fargo, ND 58102-4835 | 2014-07-08 |
| 1326462490 | Shannon Lynn Gullingsrud | Physician Assistant | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2014-02-10 |
| 1467722702 | Yan Tesch | Physician Assistant | 2400 32nd Ave S, Fargo, ND 58103-5800 | 2012-01-04 |
| Find all providers in FARGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.