Provider Demographics
NPI:1861706061
Name:GILMAN, JENELL LYNN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JENELL
Middle Name:LYNN
Last Name:GILMAN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:800 E 28TH ST
Mailing Address - Street 2:MAIL ROUTE 39602
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3723
Mailing Address - Country:US
Mailing Address - Phone:612-863-0846
Mailing Address - Fax:612-863-4689
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:MAIL ROUTE 39602
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-0846
Practice Address - Fax:612-863-4689
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2021-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1459363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical