Healthcare Provider Details

I. General information

NPI: 1881605996
Provider Name (Legal Business Name): JENNIFER E BOEVERS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 7TH ST
POCAHONTAS IA
50574-1000
US

IV. Provider business mailing address

608 NW 7TH ST
POCAHONTAS IA
50574-1000
US

V. Phone/Fax

Practice location:
  • Phone: 712-335-5632
  • Fax:
Mailing address:
  • Phone: 712-335-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3292
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: