| Doctor Name: | BONITA J JENZEN |
| NPI Number: | 1598156481 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN,CNP |
| License Number: | R34877 |
| Business Practice Address: | 275 11th St S Wahpeton, ND - 580754655 |
| Business Phone Number: | 7016422000 |
| Business Fax Number: | 7016714106 |
| Mailing Address: | Po Box 6001, FARGO |
| State: | ND |
| Postal Code: | 581086001 |
| Phone Number: | 7016422000 |
| Fax Number: | |
| NPI Enumeration Date: | 02/12/2015 |
| NPI Last Update Date: | 12/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R34877 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |