Provider Demographics
NPI:1629670021
Name:AGUIRRE, JENNA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:AGUIRRE
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 1:337 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-1409
Mailing Address - Country:US
Mailing Address - Phone:262-349-6697
Mailing Address - Fax:
Practice Address - Street 1:337 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-1409
Practice Address - Country:US
Practice Address - Phone:262-349-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI223871163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse