MEDICARE: JENNIFER SUE DELACRUZ RN, MSN

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
1	163W00000X	Registered Nurse	163633-30	WI

General Provider Information

NPI Number	:	1396098919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SUE DELACRUZ RN, MSN

Provider Business Mailing Address
First Line	:	W64N306 MADISON AVE
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53012-2331
Country	:	US
Telephone Number	:	414-559-6692
Fax Number	:

Provider Business Practice Location Address
First Line	:	W64N306 MADISON AVE
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53012-2331
Country	:	US
Telephone Number	:	414-559-6692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	08/16/2024

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