Healthcare Provider Details

I. General information

NPI: 1538251038
Provider Name (Legal Business Name): JENNIFER LYNN COMP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 W LINCOLN AVE SUITE 515
WEST ALLIS WI
53227-2468
US

IV. Provider business mailing address

8905 W LINCOLN AVE SUITE 515
WEST ALLIS WI
53227-2468
US

V. Phone/Fax

Practice location:
  • Phone: 414-328-8650
  • Fax: 414-328-8660
Mailing address:
  • Phone: 414-328-8650
  • Fax: 414-328-8660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: