Provider Demographics
NPI:1689643579
Name:JASNIEWSKI, JANET L (NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:JASNIEWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:L
Other - Last Name:PEELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3077 N MAYFAIR RD STE 305
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4305
Mailing Address - Country:US
Mailing Address - Phone:414-384-6700
Mailing Address - Fax:414-727-1058
Practice Address - Street 1:3077 N MAYFAIR RD STE 305
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4305
Practice Address - Country:US
Practice Address - Phone:414-384-6700
Practice Address - Fax:414-727-1058
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2706363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41268800Medicaid
WI41268800Medicaid
Q55078Medicare UPIN