Provider Demographics
NPI:1689356982
Name:BOCKNESS, JENIFER
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:BOCKNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16691 7TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CUMMINGS
Mailing Address - State:ND
Mailing Address - Zip Code:58223-9520
Mailing Address - Country:US
Mailing Address - Phone:701-368-1234
Mailing Address - Fax:
Practice Address - Street 1:16691 7TH ST NE
Practice Address - Street 2:
Practice Address - City:CUMMINGS
Practice Address - State:ND
Practice Address - Zip Code:58223-9520
Practice Address - Country:US
Practice Address - Phone:701-368-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant