Provider Demographics
NPI:1891451498
Name:MESSALL, JEANNIE MARIE
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:MARIE
Last Name:MESSALL
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 1:600 S 2ND ST STE 308
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5729
Mailing Address - Country:US
Mailing Address - Phone:701-223-4517
Mailing Address - Fax:
Practice Address - Street 1:1121 S 11TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6632
Practice Address - Country:US
Practice Address - Phone:701-751-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator