Healthcare Provider Details

I. General information

NPI: 1932173580
Provider Name (Legal Business Name): GENEVA ELIZABETH DOKKEN GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 34TH AVE S MC26602G
BLOOMINGTON MN
55425-1692
US

IV. Provider business mailing address

8101 34TH AVE S MC26602G
BLOOMINGTON MN
55425-1692
US

V. Phone/Fax

Practice location:
  • Phone: 952-883-6805
  • Fax: 952-883-6117
Mailing address:
  • Phone: 952-883-6805
  • Fax: 952-883-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0417392
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: