Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LP0118 | MN |
Y | 103T00000X | Psychologist | LP0118 | MN |
NPI | 1003984931 |
---|---|
Provider Name | Barbara Anne Bofenkamp |
First Address | Northfield, MN 55057 |
Second Address | Northfield, MN 55057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6220341 | UBH (01) | |
797221025211 | PREFERRED ONE (01) | |
9H002B0 | BLUE CROSS BLUE SHIELD (01) | MN |
HP20450 | HEALTH PARTNERS (01) |