Healthcare Provider Details

I. General information

NPI: 1740320035
Provider Name (Legal Business Name): JESSICA L ZEMLAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 W EDGERTON AVE
GREENFIELD WI
53220-4420
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 414-325-5244
  • Fax: 414-421-3772
Mailing address:
  • Phone: 414-325-5244
  • Fax: 414-421-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2491
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2941
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: