Healthcare Provider Details

I. General information

NPI: 1528449568
Provider Name (Legal Business Name): JENNA LEASE RN, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W180N8000 TOWN HALL RD
MENOMONEE FALLS WI
53051-4002
US

IV. Provider business mailing address

W180N8000 TOWN HALL RD
MENOMONEE FALLS WI
53051-4002
US

V. Phone/Fax

Practice location:
  • Phone: 262-532-3850
  • Fax:
Mailing address:
  • Phone: 715-432-5366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number6276
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: