Provider Demographics
NPI:1700361375
Name:JENNINGS, DEBRA JANE (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JANE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 CARTER PL
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2392
Mailing Address - Country:US
Mailing Address - Phone:608-881-6098
Mailing Address - Fax:
Practice Address - Street 1:267 CARTER PL
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2392
Practice Address - Country:US
Practice Address - Phone:608-881-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133541-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI133541-030OtherBOARD OF NURSING