Provider Demographics
NPI:1942198791
Name:EWERT, JACQUELINE DANIELLE (CNA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:DANIELLE
Last Name:EWERT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 FILMORE AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-7115
Mailing Address - Country:US
Mailing Address - Phone:701-317-8478
Mailing Address - Fax:
Practice Address - Street 1:217 FILMORE AVE
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-7115
Practice Address - Country:US
Practice Address - Phone:701-317-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND866803747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant