Healthcare Provider Details

I. General information

NPI: 1093646200
Provider Name (Legal Business Name): JESSICA LEAHANN DAKOTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-1000
US

IV. Provider business mailing address

3215 S MOORLAND RD
NEW BERLIN WI
53151-4239
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax:
Mailing address:
  • Phone: 414-384-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number236291-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: