Healthcare Provider Details

I. General information

NPI: 1447972823
Provider Name (Legal Business Name): KRISTIN RENEE JENSEN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W5829 HOELZEL WAY
APPLETON WI
54915-5301
US

IV. Provider business mailing address

W5829 HOELZEL WAY
APPLETON WI
54915-5301
US

V. Phone/Fax

Practice location:
  • Phone: 630-768-4723
  • Fax:
Mailing address:
  • Phone: 630-768-4723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12071-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: