Healthcare Provider Details

I. General information

NPI: 1467266916
Provider Name (Legal Business Name): JESSICA LEPPLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARK ST
MADISON WI
53715-1830
US

IV. Provider business mailing address

1257 COUNTY ROAD BB
DEERFIELD WI
53531-9611
US

V. Phone/Fax

Practice location:
  • Phone: 608-260-2905
  • Fax:
Mailing address:
  • Phone: 608-228-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number16451-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: