Provider Demographics
NPI:1881605996
Name:BOEVERS, JENNIFER E (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:BOEVERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IA
Mailing Address - Zip Code:50574-1000
Mailing Address - Country:US
Mailing Address - Phone:712-335-5632
Mailing Address - Fax:
Practice Address - Street 1:608 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1000
Practice Address - Country:US
Practice Address - Phone:712-335-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42231OtherWELLMARK
IA0242925Medicaid
IAH48425Medicare UPIN
IAI3350Medicare ID - Type Unspecified