Provider Demographics
NPI:1083013270
Name:BEYER, JAN S (NP)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:S
Last Name:BEYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7739 TRI COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-9152
Mailing Address - Country:US
Mailing Address - Phone:920-623-5212
Mailing Address - Fax:920-261-6693
Practice Address - Street 1:134 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3304
Practice Address - Country:US
Practice Address - Phone:920-261-6500
Practice Address - Fax:920-261-6693
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5923-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily