Healthcare Provider Details

I. General information

NPI: 1891081113
Provider Name (Legal Business Name): DEBRA JEANNE ZENNER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA JEANNE YARON

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 SOUTH GIBSON ST.
MEDFORD WI
54451
US

IV. Provider business mailing address

143 SOUTH GIBSON ST.
MEDFORD WI
54451
US

V. Phone/Fax

Practice location:
  • Phone: 715-748-2121
  • Fax: 715-748-7590
Mailing address:
  • Phone: 715-748-2121
  • Fax: 715-748-7590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4483
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number4483-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: