Healthcare Provider Details

I. General information

NPI: 1093127722
Provider Name (Legal Business Name): JENNIFER K EVANS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER K KLICKA CRNA

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 AURORA DR
SUMMIT WI
53066-4899
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-434-1000
  • Fax: 262-434-5050
Mailing address:
  • Phone: 800-326-2250
  • Fax: 414-290-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number163444-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: