Mergner, Jacky Eileen

Mergner, Jacky Eileen is an individual health care provider with primary practice located at 921 43Rd Ave N , Fargo ND 58102-5320. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics, which is considered as her primary health care specialty. Mergner, Jacky Eileen can be contacted via phone (701) 793-3646.

Contact Information

Primary practice address
921 43Rd Ave N Fargo ND 58102-5320
Phone: (701) 793-3646
Fax: (701) 293-6892
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics 225XP0200X 816 North Dakota
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics 225XP0200X 102599 Minnesota

Profile Details

NPI number 1407907082
LBN Legal business name Mergner, Jacky Eileen
Credentials OTRL
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 12th, 2007
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407907082 NPPES
North Dakota Other 26623 BCBS ND PROVIDER NUMBER
North Dakota MEDICAID 51032 BCBS ND PROVIDER NUMBER

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