Healthcare Provider Details

I. General information

NPI: 1679708317
Provider Name (Legal Business Name): ANNEMARIE JESSUP C.N.A./H.H.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 W COLDSPRING RD
GREENFIELD WI
53220-3472
US

IV. Provider business mailing address

6530 W COLDSPRING RD
GREENFIELD WI
53220-3472
US

V. Phone/Fax

Practice location:
  • Phone: 414-322-9544
  • Fax:
Mailing address:
  • Phone: 414-322-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number374U00000X
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: