Healthcare Provider Details

I. General information

NPI: 1558777235
Provider Name (Legal Business Name): JENNA R ZAFFKE D.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA STOUT APRN, NP

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 12/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 13TH AVE E
WEST FARGO ND
58078-3468
US

IV. Provider business mailing address

PO BOX 6001
FARGO ND
58108-6001
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-5751
  • Fax: 701-364-5750
Mailing address:
  • Phone: 701-364-5751
  • Fax: 701-364-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR34676
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: