Healthcare Provider Details

I. General information

NPI: 1164706099
Provider Name (Legal Business Name): JESSICA ELIZABETH WROBLEWSKI R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 12/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N52W17284 RIDGEWOOD DR
MENOMONEE FALLS WI
53051-7847
US

IV. Provider business mailing address

PO BOX 590
BROOKFIELD WI
53008-0590
US

V. Phone/Fax

Practice location:
  • Phone: 855-855-2710
  • Fax: 855-855-2710
Mailing address:
  • Phone: 855-855-2710
  • Fax: 855-855-2710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number162900-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: