Healthcare Provider Details

I. General information

NPI: 1467335059
Provider Name (Legal Business Name): AMIE LYNN BOELKE RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMIE LYNN JAGER RN, BSN

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

901 8TH AVE S APT 205
WAHPETON ND
58075-4852
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3241
  • Fax:
Mailing address:
  • Phone: 734-837-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201122
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: