Provider Demographics
NPI:1679713549
Name:MARTIN, JENNIFER L (APRN, DNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN, DNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:SCHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2940
Mailing Address - Country:US
Mailing Address - Phone:608-756-6868
Mailing Address - Fax:608-756-6289
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2940
Practice Address - Country:US
Practice Address - Phone:608-756-6868
Practice Address - Fax:608-756-6289
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3694-33363LA2200X
WI2008006024363LA2200X
WI141119-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1679713549OtherBCBSWI
WI1679713549Medicaid
WIMARTIJE3OtherMERCYCARE INSURANCE
WIMARTIJE3OtherMERCYCARE INSURANCE
WI1679713549Medicaid