Provider Demographics
NPI:1477899870
Name:NJOS SOISETH, JAMIE N (PTA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:N
Last Name:NJOS SOISETH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:N
Other - Last Name:NJOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 2397
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-2397
Mailing Address - Country:US
Mailing Address - Phone:701-572-6757
Mailing Address - Fax:701-774-3532
Practice Address - Street 1:222 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801
Practice Address - Country:US
Practice Address - Phone:701-572-6757
Practice Address - Fax:701-774-3532
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1024225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND56116Medicaid