MEDICARE: JENNIFER BOHNERT RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	225146-30	WI

General Provider Information

NPI Number	:	1336513290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BOHNERT RN

Provider Business Mailing Address
First Line	:	113 SANDY BEACH RD
Second Line	:
City	:	LAKE MILLS
State	:	WI
Zip	:	53551-1837
Country	:	US
Telephone Number	:	218-330-6016
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 SANDY BEACH RD
Second Line	:
City	:	LAKE MILLS
State	:	WI
Zip	:	53551-1837
Country	:	US
Telephone Number	:	218-330-6016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2015
Last Update Date	:	11/16/2015

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