=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275822686
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER ERIN BOECKMAN D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2011
-----------------------------------------------------
Last Update Date | 11/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 217 RADIO DR
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55125-5805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-702-0750
-----------------------------------------------------
Fax | 651-645-6166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 RADIO DR STE 202
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55125-5822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-702-0750
-----------------------------------------------------
Fax | 651-645-6166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RA0201X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
-----------------------------------------------------
License Number | 63788
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------