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NPI Code Detail

MEDICARE: JENNIFER REAGAN FNP

MEDICARE: JENNIFER REAGAN FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner5448-33WI

General Provider Information

NPI Number : 1154594208
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER REAGAN FNP
Provider Business Mailing Address
First Line : 15995 CORNELL CT
Second Line :
City : BROOKFIELD
State : WI
Zip : 53005-3253
Country : US
Telephone Number : 414-248-8666
Fax Number :
Provider Business Practice Location Address
First Line : 5800 W LAYTON AVE
Second Line :
City : GREENFIELD
State : WI
Zip : 53220-4021
Country : US
Telephone Number : 262-532-3067
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2008
Last Update Date : 09/13/2022

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