Provider Demographics
NPI:1700948536
Name:JANE E VANROEKEL
Entity Type:Organization
Organization Name:JANE E VANROEKEL
Other - Org Name:DAKOTA PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:VANROEKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-455-9697
Mailing Address - Street 1:1399 FELIX ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3207
Mailing Address - Country:US
Mailing Address - Phone:651-457-0987
Mailing Address - Fax:
Practice Address - Street 1:5975 CARMEN AVE
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-4416
Practice Address - Country:US
Practice Address - Phone:651-455-9697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21669208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty