Healthcare Provider Details

I. General information

NPI: 1649477175
Provider Name (Legal Business Name): JENNIFER YATES APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER FEENEY

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 S NICOLET RD
APPLETON WI
54914-3938
US

IV. Provider business mailing address

10001 W INNOVATION DR STE 200
MILWAUKEE WI
53226-4851
US

V. Phone/Fax

Practice location:
  • Phone: 888-938-3838
  • Fax: 888-919-1083
Mailing address:
  • Phone: 888-938-3838
  • Fax: 888-919-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3775-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: