Provider Demographics
NPI:1235330077
Name:NYGAARD, JACOB M (CPED)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:M
Last Name:NYGAARD
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 975
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-0975
Mailing Address - Country:US
Mailing Address - Phone:828-652-1989
Mailing Address - Fax:828-652-8990
Practice Address - Street 1:135 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4548
Practice Address - Country:US
Practice Address - Phone:828-652-1989
Practice Address - Fax:828-652-8990
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795082Medicaid