Healthcare Provider Details

I. General information

NPI: 1457262891
Provider Name (Legal Business Name): JENNIFER SANDERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5966 N 35TH ST
MILWAUKEE WI
53209-4055
US

IV. Provider business mailing address

5225 W VLIET ST
MILWAUKEE WI
53208-2698
US

V. Phone/Fax

Practice location:
  • Phone: 414-393-2800
  • Fax: 414-393-2815
Mailing address:
  • Phone: 414-393-2800
  • Fax: 414-393-2815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number153852-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: