Provider Demographics
NPI:1558777235
Name:ZAFFKE, JENNA R (DNP)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:R
Last Name:ZAFFKE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:STOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, NP
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-5751
Mailing Address - Fax:701-364-5750
Practice Address - Street 1:1401 13TH AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3468
Practice Address - Country:US
Practice Address - Phone:701-364-5751
Practice Address - Fax:701-364-5750
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR34676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1460469Medicaid