Healthcare Provider Details

I. General information

NPI: 1699798165
Provider Name (Legal Business Name): ABBE JENNIFER PENZINER-BOKDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DELLWOOD ST S
CAMBRIDGE MN
55008-1920
US

IV. Provider business mailing address

701 DELLWOOD ST S
CAMBRIDGE MN
55008-1920
US

V. Phone/Fax

Practice location:
  • Phone: 612-262-1166
  • Fax: 612-262-4258
Mailing address:
  • Phone: 612-262-1166
  • Fax: 612-262-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59779
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: