Healthcare Provider Details

I. General information

NPI: 1780894212
Provider Name (Legal Business Name): NANCY A. JENSCH RN CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MAPLE STREET
WOODRUFF WI
54568
US

IV. Provider business mailing address

240 MAPLE STREET P.O. BOX 470
WOODRUFF WI
54568
US

V. Phone/Fax

Practice location:
  • Phone: 715-356-8153
  • Fax: 715-356-8228
Mailing address:
  • Phone: 715-356-8153
  • Fax: 715-356-8228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: