Healthcare Provider Details

I. General information

NPI: 1609091776
Provider Name (Legal Business Name): JANE VANDER MEER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E CAMPUS MALL #6133
MADISON WI
53715-1365
US

IV. Provider business mailing address

333 E CAMPUS MALL #6133
MADISON WI
53715-1365
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-7411
  • Fax:
Mailing address:
  • Phone: 608-263-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1970
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: