Healthcare Provider Details

I. General information

NPI: 1023562758
Provider Name (Legal Business Name): JENTA ALEXANDER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7021 N 98TH ST
MILWAUKEE WI
53224-4505
US

IV. Provider business mailing address

3727 W WISCONSIN AVE
MILWAUKEE WI
53208-3182
US

V. Phone/Fax

Practice location:
  • Phone: 414-801-4306
  • Fax:
Mailing address:
  • Phone: 414-291-2626
  • Fax: 414-931-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7055-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: