Healthcare Provider Details

I. General information

NPI: 1760486625
Provider Name (Legal Business Name): JULIE ANNE JENSEN RNMSNC-ANPAPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

5931 S 116TH ST
HALES CORNERS WI
53130-2403
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax: 414-389-4106
Mailing address:
  • Phone: 414-425-3573
  • Fax: 414-389-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number65581
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: