Healthcare Provider Details

I. General information

NPI: 1659842169
Provider Name (Legal Business Name): JENNIFER MILLER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2018
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 W LAYTON AVE
MILWAUKEE WI
53220-3849
US

IV. Provider business mailing address

5223 W HILLCREST DR
MEQUON WI
53092-2012
US

V. Phone/Fax

Practice location:
  • Phone: 414-877-4570
  • Fax:
Mailing address:
  • Phone: 262-825-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number221847
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number16871
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16871
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: