Healthcare Provider Details

I. General information

NPI: 1801646245
Provider Name (Legal Business Name): JENNIFER ANN DAGGETT APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W2850 STATE ROAD 28
SHEBOYGAN FALLS WI
53085-2702
US

IV. Provider business mailing address

W2850 STATE ROAD 28
SHEBOYGAN FALLS WI
53085-2702
US

V. Phone/Fax

Practice location:
  • Phone: 920-467-1800
  • Fax: 920-467-1900
Mailing address:
  • Phone: 920-467-1800
  • Fax: 920-467-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15201-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number15201-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: