Healthcare Provider Details

I. General information

NPI: 1518269927
Provider Name (Legal Business Name): JESSICA TJADEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 N 12TH ST SUITE 1800
MILWAUKEE WI
53233-1306
US

IV. Provider business mailing address

620 S 76TH ST STE 240
MILWAUKEE WI
53214-1599
US

V. Phone/Fax

Practice location:
  • Phone: 414-278-9000
  • Fax: 414-278-9005
Mailing address:
  • Phone: 414-988-6350
  • Fax: 414-988-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4111-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: