Provider Demographics
NPI:1407238371
Name:LIFFRIG, JACQUELYN A (RN, BSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:A
Last Name:LIFFRIG
Suffix:
Gender:F
Credentials:RN, BSN, FNP-C
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:A
Other - Last Name:LAETSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:437 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:ND
Mailing Address - Zip Code:58540
Mailing Address - Country:US
Mailing Address - Phone:701-463-2245
Mailing Address - Fax:701-463-6543
Practice Address - Street 1:437 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:ND
Practice Address - Zip Code:58540
Practice Address - Country:US
Practice Address - Phone:701-463-2245
Practice Address - Fax:701-463-6543
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR37610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily