Provider Demographics
NPI:1972497550
Name:RIENKS, JEAN (RN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:RIENKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53300 BONVALE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1383
Mailing Address - Country:US
Mailing Address - Phone:574-360-7817
Mailing Address - Fax:574-360-7817
Practice Address - Street 1:53300 BONVALE DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1383
Practice Address - Country:US
Practice Address - Phone:574-360-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28079029A163WC0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management