Healthcare Provider Details

I. General information

NPI: 1982792305
Provider Name (Legal Business Name): JENNIFER MARIE LANGMAN REESE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE LANGMAN PA-C

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N MEADE ST
APPLETON WI
54911
US

IV. Provider business mailing address

PO BOX 8003
APPLETON WI
54912-8003
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-8900
  • Fax: 920-225-1479
Mailing address:
  • Phone: 920-738-4780
  • Fax: 920-738-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2065
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: