Healthcare Provider Details

I. General information

NPI: 1023947553
Provider Name (Legal Business Name): JENNIFER MARLENA HONAN ABARQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8731 ELLIOT AVE S
BLOOMINGTON MN
55420-3023
US

IV. Provider business mailing address

8731 ELLIOT AVE S
BLOOMINGTON MN
55420-3023
US

V. Phone/Fax

Practice location:
  • Phone: 612-770-8065
  • Fax:
Mailing address:
  • Phone: 718-207-5822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number91964
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: