Provider Demographics
NPI:1285024695
Name:KOFLER, JENNIFER MARY (RN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARY
Last Name:KOFLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARY
Other - Last Name:KOFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:148070-30
Mailing Address - Street 1:5332 S 46TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-5006
Mailing Address - Country:US
Mailing Address - Phone:414-759-8834
Mailing Address - Fax:
Practice Address - Street 1:5332 S 46TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-5006
Practice Address - Country:US
Practice Address - Phone:414-759-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148070-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse