Healthcare Provider Details

I. General information

NPI: 1447182241
Provider Name (Legal Business Name): JENNIFER SYDOW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 COMMUNITY DR
WAUNAKEE WI
53597-1655
US

IV. Provider business mailing address

301 COMMUNITY DR
WAUNAKEE WI
53597-1655
US

V. Phone/Fax

Practice location:
  • Phone: 608-209-9950
  • Fax: 608-849-2164
Mailing address:
  • Phone: 608-209-9950
  • Fax: 608-849-2164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number192740-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: