Provider Demographics
NPI:1639452386
Name:HOENIG, JENNIFER A
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:HOENIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 MILL ST
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54230-1700
Mailing Address - Country:US
Mailing Address - Phone:920-754-4337
Mailing Address - Fax:
Practice Address - Street 1:106 MILL ST
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54230-1700
Practice Address - Country:US
Practice Address - Phone:920-754-4337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4648363L00000X
WI4648-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12321109OtherCAQH
WI322700018OtherMEDICARE PTAN
WI100018444Medicaid
WIK400369945/73975Medicare PIN