Individual
JADE PAKKALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1905 2ND ST SE STE 1B, MINOT, ND 58701-6566
(701) 838-7800
Mailing address
3911 20TH AVE S, FARGO, ND 58103-4705
(701) 235-7341
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
00000
ND
174400000X
Specialist
—
—
Other
Enumeration date
12/03/2020
Last updated
12/10/2020
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