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NPI Code Detail

MEDICARE: ELIZABETH ANN JETTON NP

MEDICARE: ELIZABETH ANN JETTON NP
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
1363L00000XNurse Practitioner16876-33WI

General Provider Information

NPI Number : 1629962105
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH ANN JETTON NP
Provider Business Mailing Address
First Line : PO BOX 19070
Second Line :
City : GREEN BAY
State : WI
Zip : 54307-9070
Country : US
Telephone Number : 920-496-4700
Fax Number :
Provider Business Practice Location Address
First Line : 1821 S WEBSTER AVE
Second Line :
City : GREEN BAY
State : WI
Zip : 54301-2253
Country : US
Telephone Number : 920-496-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2025
Last Update Date : 03/06/2026

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Directions to “ ELIZABETH ANN JETTON NP” Practice Location

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