Provider Demographics
NPI:1417578204
Name:STARKE, JENNIFER M (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:STARKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 CARDIFF CT
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2510
Mailing Address - Country:US
Mailing Address - Phone:262-225-7452
Mailing Address - Fax:
Practice Address - Street 1:709 CARDIFF CT
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-2510
Practice Address - Country:US
Practice Address - Phone:262-225-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310422164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse