Healthcare Provider Details

I. General information

NPI: 1871841510
Provider Name (Legal Business Name): JENELLE MONCHE' WARD RN, APNP, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 03/20/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 W RESEARCH DR
MILWAUKEE WI
53226-3452
US

IV. Provider business mailing address

3273 N 24TH PL
MILWAUKEE WI
53206-1212
US

V. Phone/Fax

Practice location:
  • Phone: 414-443-4530
  • Fax:
Mailing address:
  • Phone: 414-736-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number156128-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number00140605
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number13739-33
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number13739-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: