Provider Demographics
NPI:1538911623
Name:SKJORDAL, JESSICA M (LPN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:SKJORDAL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LARIMORE
Mailing Address - State:ND
Mailing Address - Zip Code:58251-4704
Mailing Address - Country:US
Mailing Address - Phone:701-430-6808
Mailing Address - Fax:
Practice Address - Street 1:620 W 9TH ST
Practice Address - Street 2:
Practice Address - City:LARIMORE
Practice Address - State:ND
Practice Address - Zip Code:58251-4704
Practice Address - Country:US
Practice Address - Phone:701-430-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL10871251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health