Dorothy Lee Jenicke, STUDENT

NPI #1053088245 in Bloomington, Minnesota

Provider Information

NPI Number: 1053088245
Entity Type: Individual
Name: Dorothy Lee Jenicke, STUDENT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Student in an Organized Health Care Education/Training Program
Credential: STUDENT
Enumeration Date: Aug 25, 2021
Last Updated: Nov 13, 2024

Practice Location

Address: 8053 E BLOOMINGTON FWY
City: Bloomington
State: Minnesota
ZIP Code: 55420-4577
Phone: (612) 333-2155

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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