Healthcare Provider Details

I. General information

NPI: 1154594208
Provider Name (Legal Business Name): JENNIFER REAGAN APNP, PMHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W GLEN OAKS LN STE 1
MEQUON WI
53092-3477
US

IV. Provider business mailing address

1045 W GLEN OAKS LN STE 1
MEQUON WI
53092-3477
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-7778
  • Fax: 262-241-8200
Mailing address:
  • Phone: 262-241-7778
  • Fax: 262-241-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5448-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5448
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: