Healthcare Provider Details

I. General information

NPI: 1356347686
Provider Name (Legal Business Name): WENDY R. JANSSEN MS, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W. NATIONAL AVE
MILWAUKEE WI
53295
US

IV. Provider business mailing address

3614 N. 92ND ST.
MILWAUKEE WI
53222-2604
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax: 414-382-5327
Mailing address:
  • Phone: 414-384-2000
  • Fax: 414-382-5327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1546-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: