Basic Information
| Provider Information | |||||||||
| NPI: | 1376521393 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JILEK | ||||||||
| FirstName: | MARLENE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | RN NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8674 | ||||||||
| Address2: | 1230 E MAIN ST MANKATO CLINIC LTD | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | MANKATO CLINIC @ MAIN STREET | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560015066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R0894533 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1200703 | 01 | MN | MEDICA | OTHER | 124543 | 01 | MN | UCARE | OTHER | 41084933956001C117 | 01 | CHAMPUS | OTHER | 938134 | 01 | IA | MEDICAID | OTHER | 500009833 | 01 | RR MEDICARE | OTHER | 1652148 | 01 | MN | AMERICAS PPO | OTHER | 87837JI | 01 | MN | BCBS | OTHER | 811242800 | 05 | MN | MEDICAID | NA2951023874 | 01 | MN | PREFFERED ONE | OTHER | HP41025 | 01 | MN | HEALTH PARTNERS | OTHER |