Provider Demographics
NPI:1649580283
Name:ZELLMER, JENNIFER M (APNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:ZELLMER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:TIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:700 S PARK ST STE A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1830
Mailing Address - Country:US
Mailing Address - Phone:608-260-2900
Mailing Address - Fax:608-260-3447
Practice Address - Street 1:700 S PARK ST STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-260-2900
Practice Address - Fax:608-260-3447
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4190-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1649580283Medicaid
WI61093OtherDEAN HEALTH INSURANCE