Female

Agnes L. Jackai APRN, CNP, PMHNP-BC

Full Name

Agnes Limunga Jackai APRN, CNP, PMHNP-BC

NPI Number

1891403135

NPI Type

Individual Provider

Gender

Female

Enumeration Date

11/07/2022

Specialties

(Taxonomies)

Code

363LP0808X

Primary Taxonomy

No

Licenses

State

Minnesota

License Number

PENDING

Contact
Information

Purpose

Mailing
Location

Address

12125 VERMILLION ST NE UNIT E
12125 VERMILLION ST NE UNIT E

City

Blaine
Blaine

State

MN
MN

Postal Code

55449-5678
55449-5678

Country

US
US

Telephone Number

(612) 598-3937
(612) 598-3937

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 03/22/2023

Provider Address