| Doctor Name: | JILL ILENE RETTERATH |
| NPI Number: | 1427303221 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | R 206925-6 |
| Business Practice Address: | 2199 Highway 36 E North Saint Paul, MN - 551092215 |
| Business Phone Number: | 6517795986 |
| Business Fax Number: | |
| Mailing Address: | 11246 Hidden Oaks Ct N, CHAMPLIN |
| State: | MN |
| Postal Code: | 553163038 |
| Phone Number: | 7018801446 |
| Fax Number: | |
| NPI Enumeration Date: | 07/17/2012 |
| NPI Last Update Date: | 07/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R 206925-6 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |