Provider Demographics
NPI:1548223746
Name:JENNRICH, HEIDI J (APNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:JENNRICH
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 1:500 MCMILLEN STREET
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1223
Mailing Address - Country:US
Mailing Address - Phone:950-563-5571
Mailing Address - Fax:920-563-7705
Practice Address - Street 1:500 MCMILLEN STREET
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1223
Practice Address - Country:US
Practice Address - Phone:950-563-5571
Practice Address - Fax:920-563-7705
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2334-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41258200Medicaid
WI41258200Medicaid
WIMD1157014OtherDEA