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General NPI Number Information
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NPI Number | 1548223746
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Entity Type | Individual
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Provider Name | HEIDI J JENNRICH APNP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 500 MCMILLEN STREET
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City | FORT ATKINSON
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State | WI
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Zip | 53538-1223
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Country | US
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Telephone | 950-563-5571
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Fax | 920-563-7705
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Provider Business Mailing Address
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Address Line | 500 MCMILLEN STREET
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City | FORT ATKINSON
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State | WI
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Zip | 53538-1223
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Country | US
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Telephone | 950-563-5571
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Fax | 920-563-7705
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2334-33
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License Number State | WI
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