Healthcare Provider Details

I. General information

NPI: 1043078090
Provider Name (Legal Business Name): JACKLINE N. OGARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1396 108TH AVE NE
BLAINE MN
55434-3705
US

IV. Provider business mailing address

1396 108TH AVE NE
BLAINE MN
55434-3705
US

V. Phone/Fax

Practice location:
  • Phone: 763-843-0124
  • Fax:
Mailing address:
  • Phone: 763-843-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2270443
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: