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General NPI Number Information
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NPI Number | 1598156481
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Entity Type | Individual
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Provider Name | BONITA J JENZEN APRN,CNP
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Gender | Female
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 275 11TH ST S
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City | WAHPETON
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State | ND
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Zip | 58075-4655
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Country | US
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Telephone | 701-642-2000
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Fax | 701-671-4106
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Provider Business Mailing Address
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Address Line | PO BOX 6001
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City | FARGO
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State | ND
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Zip | 58108-6001
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Country | US
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Telephone | 701-642-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R34877
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License Number State | ND
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