Healthcare Provider Details

I. General information

NPI: 1336569185
Provider Name (Legal Business Name): JAGILA MINSO MD, MPH, FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAGILA MINSO WESLEY MD., MPH

II. Dates (important events)

Enumeration Date: 04/20/2014
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 7TH ST
BISMARCK ND
58501-4439
US

IV. Provider business mailing address

2220 N DRUID HILLS RD NE
BROOKHAVEN GA
30329-3117
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number80124
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number14527
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: