Provider Demographics
NPI:1114116571
Name:LEIN, JEAN M (RN)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:M
Last Name:LEIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16680 MARY CLIFF LN
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2134
Mailing Address - Country:US
Mailing Address - Phone:262-783-4327
Mailing Address - Fax:
Practice Address - Street 1:16680 MARY CLIFF LN
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2134
Practice Address - Country:US
Practice Address - Phone:262-783-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI96754-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse