Provider Demographics
NPI:1932377991
Name:NEUBAUER, JENNIFER A (APNP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:1 NORTHWESTERN MUTUAL WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9497
Mailing Address - Country:US
Mailing Address - Phone:414-661-8400
Mailing Address - Fax:414-661-5730
Practice Address - Street 1:1 NORTHWESTERN MUTUAL WAY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9497
Practice Address - Country:US
Practice Address - Phone:414-661-8400
Practice Address - Fax:414-661-5730
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3306363LF0000X
WI141143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1932377991Medicaid
WI1117 73-601Medicare PIN
WIK400212712Medicare PIN