Provider Demographics
NPI:1649596925
Name:ALBERT, JENNIFER BETH (APN/CNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BETH
Last Name:ALBERT
Suffix:
Gender:F
Credentials:APN/CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10222 74TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-6810
Mailing Address - Country:US
Mailing Address - Phone:262-697-9200
Mailing Address - Fax:262-697-9206
Practice Address - Street 1:10222 74TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-6810
Practice Address - Country:US
Practice Address - Phone:262-697-9200
Practice Address - Fax:262-697-9206
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-006009363LW0102X
WI4028363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100009125Medicaid