Provider Demographics
NPI:1477854016
Name:ERNST, JESSICA ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN
Last Name:ERNST
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 1:310 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53170-1728
Mailing Address - Country:US
Mailing Address - Phone:262-885-6010
Mailing Address - Fax:
Practice Address - Street 1:310 E LAKE ST
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:WI
Practice Address - Zip Code:53170-1728
Practice Address - Country:US
Practice Address - Phone:262-885-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171632-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse