Provider Demographics
NPI:1508234188
Name:ANGOVE, JESSICA (APNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ANGOVE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2779 COUNTY ROAD M
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-3856
Mailing Address - Country:US
Mailing Address - Phone:920-342-7616
Mailing Address - Fax:
Practice Address - Street 1:2717 N GRANDVIEW BLVD STE 202
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1660
Practice Address - Country:US
Practice Address - Phone:262-513-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-12
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6569-33363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology