Healthcare Provider Details

I. General information

NPI: 1245534361
Provider Name (Legal Business Name): MRS. JENNIFER A KIND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E CAMPUS MALL
MADISON WI
53715-1365
US

IV. Provider business mailing address

333 E CAMPUS MALL
MADISON WI
53715-1365
US

V. Phone/Fax

Practice location:
  • Phone: 608-262-0932
  • Fax: 608-890-2203
Mailing address:
  • Phone: 608-262-0932
  • Fax: 608-890-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number144615-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: