MEDICARE: HEIDI J JENNRICH APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	2334-33	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548223746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI J JENNRICH APNP

Provider Business Mailing Address
First Line	:	500 MCMILLEN STREET
Second Line	:
City	:	FORT ATKINSON
State	:	WI
Zip	:	53538-1223
Country	:	US
Telephone Number	:	950-563-5571
Fax Number	:	920-563-7705

Provider Business Practice Location Address
First Line	:	500 MCMILLEN STREET
Second Line	:
City	:	FORT ATKINSON
State	:	WI
Zip	:	53538-1223
Country	:	US
Telephone Number	:	950-563-5571
Fax Number	:	920-563-7705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	03/07/2023

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