Healthcare Provider Details

I. General information

NPI: 1508053117
Provider Name (Legal Business Name): JENNIFER T. WESTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. JENNIFER T. SCHMIT

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W PARADISE DR
WEST BEND WI
53095-9795
US

IV. Provider business mailing address

1700 W PARADISE DR
WEST BEND WI
53095-9795
US

V. Phone/Fax

Practice location:
  • Phone: 262-677-7868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2197
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2197
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: