Healthcare Provider Details

I. General information

NPI: 1972497550
Provider Name (Legal Business Name): JEAN RIENKS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53300 BONVALE DR
SOUTH BEND IN
46635-1383
US

IV. Provider business mailing address

53300 BONVALE DR
SOUTH BEND IN
46635-1383
US

V. Phone/Fax

Practice location:
  • Phone: 574-360-7817
  • Fax:
Mailing address:
  • Phone: 574-360-7817
  • Fax: 574-360-7817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number28079029A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number28079029A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: