Provider Demographics
NPI:1417780792
Name:NYGAARD, JADA
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:
Last Name:NYGAARD
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 1:103 COLLEGE DR N UNIT 3
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2931
Mailing Address - Country:US
Mailing Address - Phone:701-544-1000
Mailing Address - Fax:
Practice Address - Street 1:103 COLLEGE DR N UNIT 3
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2931
Practice Address - Country:US
Practice Address - Phone:701-544-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND19189225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist