Provider Demographics
NPI:1396452561
Name:OAKDEN, JACKLYN NICOLE
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:NICOLE
Last Name:OAKDEN
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 1:7820 114TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2708
Mailing Address - Country:US
Mailing Address - Phone:763-228-7997
Mailing Address - Fax:
Practice Address - Street 1:7820 114TH AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2708
Practice Address - Country:US
Practice Address - Phone:763-228-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN823721164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse