Basic Information
| Provider Information | |||||||||
| NPI: | 1407847551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THILL | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 CENTRA CARE CIR #1300 | ||||||||
| Address2: | CENTRA CARE CLINIC WOMEN'S & CHILDREN'S | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563035000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206543610 | ||||||||
| FaxNumber: | 3206543657 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 CENTRA CARE CIR #1300 | ||||||||
| Address2: | CENTRA CARE CLINIC WOMEN'S & CHILDREN'S | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563035000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206543610 | ||||||||
| FaxNumber: | 3206543657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 12/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | R-095701-4 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0200X | R095701-4 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 136613100 | 01 | MEDICAL ASSISTANCE | OTHER | 06-28-04 | 01 | CHAMPUS | OTHER | 267L3BE | 01 | BLUE CROSS BLUE SHIELD | OTHER | HP31039 | 01 | HEALTH PARTNERS | OTHER | 2172435 | 01 | ARAZ GROUP AMERICAS PPO | OTHER | 7-22-04 | 01 | MMSI | OTHER | 1025652 | 01 | PREFERRED ONE | OTHER | 6-28-04 | 01 | ONEHEALTH PLAN/GREAT WEST | OTHER | 1202912 | 01 | MEDICA HEALTH PLANS | OTHER | 151365 | 01 | U-CARE | OTHER | 6-28-04 | 01 | FIRST HEALTH PLAN | OTHER |