Provider Demographics
NPI:1922573773
Name:KUPSER, JESSICA (BSN RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KUPSER
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 WINDSTONE DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1658
Mailing Address - Country:US
Mailing Address - Phone:414-630-8104
Mailing Address - Fax:
Practice Address - Street 1:415 BLACK EARTH RD
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:WI
Practice Address - Zip Code:53183-9759
Practice Address - Country:US
Practice Address - Phone:414-630-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI143519-30163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice