Healthcare Provider Details

I. General information

NPI: 1538714324
Provider Name (Legal Business Name): JENNIFER N MCLEOD APNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER NICOLE REYNOLDS

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 NORTH AVE
HARTLAND WI
53029-1719
US

IV. Provider business mailing address

327 NORTH AVE
HARTLAND WI
53029-1719
US

V. Phone/Fax

Practice location:
  • Phone: 262-369-4391
  • Fax: 262-369-4392
Mailing address:
  • Phone: 262-424-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number193868
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number193868
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9809
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9809-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: