Provider Demographics
NPI:1942227822
Name:NYGAARD, JEAN M (RNFNP PAC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:NYGAARD
Suffix:
Gender:F
Credentials:RNFNP PAC
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 C
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730-0658
Practice Address - Country:US
Practice Address - Phone:701-965-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR15464363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19648Medicaid
ND4702OtherNORTH DAKOTA BLUE SHIELD
R 02167Medicare UPIN
ND19648Medicaid