MEDICARE: HEIDI J JENNRICH APNP

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	363L00000X	Nurse Practitioner	2334-33	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548223746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI J JENNRICH APNP

Provider Business Mailing Address
First Line	:	500 MCMILLEN STREET
Second Line	:
City	:	FORT ATKINSON
State	:	WI
Zip	:	53538-1223
Country	:	US
Telephone Number	:	950-563-5571
Fax Number	:	920-563-7705

Provider Business Practice Location Address
First Line	:	500 MCMILLEN STREET
Second Line	:
City	:	FORT ATKINSON
State	:	WI
Zip	:	53538-1223
Country	:	US
Telephone Number	:	950-563-5571
Fax Number	:	920-563-7705

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	03/07/2023

Similar Medicare Providers

1457358699 — RICKY D EDWARDS MD
Practice Location Address:

1223 S MAIN ST
FORT WORTH, TX
76104-4804

Practice Phone: 817-702-7314
Practice Fax: 817-702-7315

1215942339 — WALGREEN CO
Practice Location Address:

1701 E PAULDING RD
FORT WAYNE, IN
46816-1223

Practice Phone: 260-456-3429
Practice Fax:

1013050319 — MRS. JANICE KAY FAULKNER OPTICIAN OWNER
Practice Location Address:

1223 5TH AVE
FORT WORTH, TX
76104

Practice Phone: 817-870-1291
Practice Fax: 817-870-4928

1023140860 — FIFTH AVENUE EYEWEAR
Practice Location Address:

1223 5TH AVE
FORT WORTH, TX
76104-4304

Practice Phone: 817-870-1291
Practice Fax: 817-870-4928

1194955278 — MELISSA DERVISHIAN
Practice Location Address:

28 TORY FORT LN
WORCESTER, MA
01602-1223

Practice Phone: 508-752-4109
Practice Fax:

1619259488 — RAYMOND L STEWART
Practice Location Address:

1701 E PAULDING RD
FORT WAYNE, IN
46816-1223

Practice Phone: 260-456-3429
Practice Fax: 260-456-3555

Directions to “ HEIDI J JENNRICH APNP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.