MEDICARE: MISS JENNIFER B RICKERT 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	363LF0000X	Family Nurse Practitioner	12100-33	WI

General Provider Information

NPI Number	:	1679209324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JENNIFER B RICKERT APNP

Provider Business Mailing Address
First Line	:	748 W 8TH AVE
Second Line	:
City	:	OSHKOSH
State	:	WI
Zip	:	54902-5859
Country	:	US
Telephone Number	:	920-312-1287
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 E SHEBOYGAN ST
Second Line	:
City	:	CAMPBELLSPORT
State	:	WI
Zip	:	53010-2795
Country	:	US
Telephone Number	:	920-533-8361
Fax Number	:

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

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	07/26/2022

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