Healthcare Provider Details

I. General information

NPI: 1710282355
Provider Name (Legal Business Name): JENNIFER LYNN FORKNER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 5TH AVE SE
CEDAR RAPIDS IA
52403-2421
US

IV. Provider business mailing address

811 5TH AVE SE
CEDAR RAPIDS IA
52403-2421
US

V. Phone/Fax

Practice location:
  • Phone: 319-365-7581
  • Fax: 319-365-0163
Mailing address:
  • Phone: 319-329-5104
  • Fax: 319-365-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA117562
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: