Provider Demographics
NPI:1336497197
Name:KRALL, JENNIFER THERESE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:THERESE
Last Name:KRALL
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:T9376 N 33RD ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-9482
Mailing Address - Country:US
Mailing Address - Phone:715-370-1869
Mailing Address - Fax:
Practice Address - Street 1:500 WIND RIDGE DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4173
Practice Address - Country:US
Practice Address - Phone:715-847-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4975-33363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care