Healthcare Provider Details

I. General information

NPI: 1003193392
Provider Name (Legal Business Name): JENNIFER LYNN HOTZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2837 MAIN ST
EAST TROY WI
53120-1352
US

IV. Provider business mailing address

2837 MAIN ST
EAST TROY WI
53120-1352
US

V. Phone/Fax

Practice location:
  • Phone: 262-607-0149
  • Fax:
Mailing address:
  • Phone: 262-607-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number157240-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: