Provider Demographics
NPI:1255506929
Name:BATA, JENNIE JON (DNP)
Entity Type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:JON
Last Name:BATA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MRS
Other - First Name:JENNIE
Other - Middle Name:JON
Other - Last Name:SWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:COLERAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55722-0870
Mailing Address - Country:US
Mailing Address - Phone:701-331-3989
Mailing Address - Fax:
Practice Address - Street 1:516 S POKEGAMA AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3820
Practice Address - Country:US
Practice Address - Phone:218-327-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR30139363LF0000X
MN7612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily