Healthcare Provider Details

I. General information

NPI: 1851672489
Provider Name (Legal Business Name): JENNIFER JOY RICHARDS APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KK RIVER PKWY SUITE 1030
MILWAUKEE WI
53215-3669
US

IV. Provider business mailing address

6418 RIVERDALE LN
GREENDALE WI
53129-2852
US

V. Phone/Fax

Practice location:
  • Phone: 414-908-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4556-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: