Healthcare Provider Details

I. General information

NPI: 1962231290
Provider Name (Legal Business Name): JADYN ALLIE SAGERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2891 2ND AVE N RM 200
GRAND FORKS ND
58202-6062
US

IV. Provider business mailing address

610 S 18TH STREET
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-777-2127
  • Fax: 701-777-4189
Mailing address:
  • Phone: 701-757-0589
  • 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 StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: