Healthcare Provider Details

I. General information

NPI: 1558604843
Provider Name (Legal Business Name): JENNIFER A JUNGHEN APRN, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER A LUESSENHOP

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 09/29/2026
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 HOBBS DR
DELAVAN WI
53115-2027
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 262-740-4200
  • Fax:
Mailing address:
  • Phone: 414-389-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5268
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5267-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: