Provider Demographics
NPI:1194413658
Name:JAKUBIAK, MARGURITE CAMILLE
Entity type:Individual
Prefix:
First Name:MARGURITE
Middle Name:CAMILLE
Last Name:JAKUBIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE # AO-102
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-624-3113
Mailing Address - Fax:612-626-6601
Practice Address - Street 1:2450 RIVERSIDE AVE # AO-102
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-624-3113
Practice Address - Fax:612-626-6601
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program