Provider Demographics
NPI:1396041299
Name:KAMPHENKEL, JENNA LITE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LITE
Last Name:KAMPHENKEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24336 726TH AVE
Mailing Address - Street 2:
Mailing Address - City:DASSEL
Mailing Address - State:MN
Mailing Address - Zip Code:55325-3567
Mailing Address - Country:US
Mailing Address - Phone:320-309-4617
Mailing Address - Fax:
Practice Address - Street 1:24336 726TH AVE
Practice Address - Street 2:
Practice Address - City:DASSEL
Practice Address - State:MN
Practice Address - Zip Code:55325-3567
Practice Address - Country:US
Practice Address - Phone:320-309-4617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-188984-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse