Individual
JACKLINE ONGECHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8017 IDAHO CIR N, BROOKLYN PARK, MN 55445-2618
(763) 227-3482
Mailing address
10358 ORCHARD TRL N, BROOKLYN PARK, MN 55443-1895
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R197472-4
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A537460500
MHCP #
MN
Enumeration date
02/12/2020
Last updated
02/12/2020
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