Healthcare Provider Details

I. General information

NPI: 1023220332
Provider Name (Legal Business Name): JESSICA K TISCHLER MSN-CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W SUMNER ST
HARTFORD WI
53027-1400
US

IV. Provider business mailing address

1700 W PARADISE DR
WEST BEND WI
53095-9795
US

V. Phone/Fax

Practice location:
  • Phone: 262-670-4824
  • Fax: 262-306-2964
Mailing address:
  • Phone: 262-334-3451
  • Fax: 262-306-2964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number137925-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: