Provider Demographics
NPI:1043974066
Name:AGUERO, JAYME E (APNP)
Entity Type:Individual
Prefix:MRS
First Name:JAYME
Middle Name:E
Last Name:AGUERO
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:JAYME
Other - Middle Name:E
Other - Last Name:BEUKELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:950 WOODLAKE RD
Mailing Address - Street 2:
Mailing Address - City:KOHLER
Mailing Address - State:WI
Mailing Address - Zip Code:53044-1348
Mailing Address - Country:US
Mailing Address - Phone:920-783-3150
Mailing Address - Fax:
Practice Address - Street 1:950 WOODLAKE RD
Practice Address - Street 2:
Practice Address - City:KOHLER
Practice Address - State:WI
Practice Address - Zip Code:53044-1348
Practice Address - Country:US
Practice Address - Phone:920-496-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11471-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100188259Medicaid