Healthcare Provider Details

I. General information

NPI: 1912812405
Provider Name (Legal Business Name): JENNA WAARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W177N7909 TAMARACK SPRINGS CIR
MENOMONEE FALLS WI
53051-4223
US

IV. Provider business mailing address

W177N7909 TAMARACK SPRINGS CIR
MENOMONEE FALLS WI
53051-4223
US

V. Phone/Fax

Practice location:
  • Phone: 224-388-2687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: