Provider Demographics
NPI:1841242443
Name:CONNER, JEANNE E (APNP)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:E
Last Name:CONNER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 S MOORLAND RD
Mailing Address - Street 2:ALLERGY AND IMMUNOLOGY
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-7494
Mailing Address - Country:US
Mailing Address - Phone:262-432-7703
Mailing Address - Fax:262-432-7798
Practice Address - Street 1:4855 S MOORLAND RD
Practice Address - Street 2:ALLERGY AND IMMUNOLOGY
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7494
Practice Address - Country:US
Practice Address - Phone:262-432-7703
Practice Address - Fax:262-432-7798
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI219363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000030377EOtherHUMANA
WI1841242443Medicaid
000030377EOtherHUMANA
WI68086 0799Medicare PIN
WI0234 73-601Medicare PIN