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:
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 1:2310 NW 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2135
Practice Address - Country:US
Practice Address - Phone:701-331-3989
Practice Address - Fax:218-327-0456
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR30139363LF0000X, 363LP0808X
MN7612363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily