Individual
JENNIFER BOELTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
251 COUNTY RD 120, SAINT CLOUD, MN 56303-4665
(320) 202-8949
(320) 202-0756
Mailing address
251 COUNTY RD 120, SAINT CLOUD, MN 56303-4665
(320) 202-8949
(320) 202-0756
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41579
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
841595100
—
MN
Enumeration date
07/03/2006
Last updated
11/23/2010
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