Provider Demographics
NPI:1093003055
Name:BERENDZEN, JENNA ZALK (DNP, PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ZALK
Last Name:BERENDZEN
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 W 1ST ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2625
Mailing Address - Country:US
Mailing Address - Phone:319-281-0179
Mailing Address - Fax:319-595-4294
Practice Address - Street 1:506 W 1ST ST STE 2
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2625
Practice Address - Country:US
Practice Address - Phone:319-281-0179
Practice Address - Fax:319-595-4294
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-113221363LF0000X
IAG555183363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0076372Medicaid