Provider Demographics
NPI:1750582482
Name:OELFKE, JACQUELINE ELIZABETH (APN-CFNP)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ELIZABETH
Last Name:OELFKE
Suffix:
Gender:F
Credentials:APN-CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2189 SHADY NOOK RD
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-1713
Mailing Address - Country:US
Mailing Address - Phone:218-829-0643
Mailing Address - Fax:
Practice Address - Street 1:CBHH-BAXTER
Practice Address - Street 2:14241 GRAND OAKS DR.
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:218-316-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 111531-8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily