AGATHA J OTTEM LILL (NPI# 1093236267) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093236267 |
| Entity Type | Individual |
| Full Name | AGATHA J OTTEM LILL |
| Other Name | AGATHA J OTTEM |
| Credential | PA-C |
| Practice Address |
4440 S Washington St Grand Forks ND 58201-7245 |
| Mailing Address |
2401 Demers Ave Grand Forks ND 58201-4183 |
| Practice Telephone | 7017327000 |
| Mailing Telephone | 7017805000 |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2020-11-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0689 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4440 S WASHINGTON ST |
| City | GRAND FORKS |
| State | ND |
| Zip Code | 58201-7245 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497846299 | Brenda K Hanson | Physician Assistant | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2006-09-27 |
| 1942832456 | Qin Du | Orthopaedic Surgery | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2020-02-12 |
| 1477036374 | Alexandra Webb | Audiologist | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-09-07 |
| 1538647722 | Rebecca Pulkrabek | Nurse Practitioner | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-07-31 |
| 1083100036 | Nicole Morgan | Nurse Practitioner | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-07-02 |
| 1760984892 | Todd Jensen | Specialist/Technologist | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-03-05 |
| 1629519418 | Bennett Leitch | Specialist/Technologist | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2017-03-14 |
| 1699214387 | Altru Health System | Clinic/Center | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2017-02-15 |
| 1548654585 | Megan Nicole Kipp | Physician Assistant | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2015-03-27 |
| 1720428519 | Mark Strand | Otolaryngology | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2013-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255965398 | Development Homes Inc | Intermediate Care Facility, Mentally Retarded | 5509 Cottonwood Street, Grand Forks, ND 58201 | 2020-02-27 |
| 1932753779 | Lydia Pansegrau | Occupational Therapist | 2950 36th Ave S, Apt A-11, Grand Forks, ND 58201 | 2019-07-30 |
| 1407416019 | Kristina Aikens | Optometrist | 1820 S 42nd St, Grand Forks, ND 58201 | 2019-06-17 |
| 1861963209 | Jessica Kovsky | Occupational Therapist | 1375 S Columbia Rd- Altru Performance Center, Grand Forks, ND 58201 | 2018-12-11 |
| 1609345834 | Altru Specialty Services, Inc | Durable Medical Equipment & Medical Supplies | 1375 South Columbia Road, Suite A, Grand Forks, ND 58201 | 2018-11-16 |
| 1225523004 | Alicia Mae Mack | Registered Nurse | 212 S. 4th St. Suite 301, Spectra Health, Grand Forks, ND 58201 | 2018-06-25 |
| 1396260808 | Amber White | Behavior Technician | 2016 S Washington St., Grand Forks, ND 58201 | 2017-08-04 |
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1881148906 | Melissa Pytlik Monson | Physician Assistant | 1380 S Columbia Rd - Altru Family Medcine Center, Grand Forks, ND 58201 | 2016-08-05 |
| 1477936029 | Laura Jane Carlson | Nurse Practitioner | 3165 Demers Avenue - Truyu Aesthetic Center, Grand Forks, ND 58201 | 2015-07-01 |
| Find all providers in zip 58201 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881148906 | Melissa Pytlik Monson | Physician Assistant | 1380 S Columbia Rd - Altru Family Medcine Center, Grand Forks, ND 58201 | 2016-08-05 |
| 1497846299 | Brenda K Hanson | Physician Assistant | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2006-09-27 |
| 1073521738 | Ruth Ann Green | Physician Assistant | 4440 S Washington St. - Altru Professional Center, Grand Forks, ND 58201-7245 | 2006-08-04 |
| 1518923994 | Nicole Anvinson | Physician Assistant | 2424 32nd Ave S, Ste 202, Grand Forks, ND 58201-6545 | 2006-04-25 |
| 1770549941 | Paula Osowski | Physician Assistant | 2424 32nd Ave S Ste 202, Grand Forks, ND 58201-6545 | 2006-04-25 |
| 1306819941 | David B Eberly | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2006-02-13 |
| 1073137915 | Hannah Lee Abner | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8155 | 2020-06-06 |
| 1952957847 | Arthur Thorsen | Physician Assistant | 1300 S Columbia Rd, Grand Forks, ND 58201 | 2019-08-15 |
| 1023663598 | Devon Nicole Anderson | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2019-08-01 |
| 1255983888 | Danielle Collins | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2019-07-13 |
| Find all providers in GRAND FORKS | ||||
| City | GRAND FORKS |
| Zip Code | 58201 |
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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.