Provider Demographics
NPI:1578731899
Name:KASSENS, JANE M (APRN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:KASSENS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-5754
Mailing Address - Country:US
Mailing Address - Phone:262-532-3127
Mailing Address - Fax:262-532-3128
Practice Address - Street 1:2180 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-5754
Practice Address - Country:US
Practice Address - Phone:262-532-3127
Practice Address - Fax:262-532-3128
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN105066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily