Provider Demographics
NPI:1275822686
Name:BOECKMAN, JENNIFER ERIN (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ERIN
Last Name:BOECKMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 SNELLING AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1525
Mailing Address - Country:US
Mailing Address - Phone:651-698-0386
Mailing Address - Fax:651-698-0483
Practice Address - Street 1:565 SNELLING AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1525
Practice Address - Country:US
Practice Address - Phone:651-698-0386
Practice Address - Fax:651-698-0483
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN63788207RA0201X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology