Provider Demographics
NPI:1952685794
Name:RESCH, JENNIFER E (APNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:RESCH
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 1:1420 ALGOMA ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-2104
Mailing Address - Country:US
Mailing Address - Phone:920-982-8300
Mailing Address - Fax:
Practice Address - Street 1:1420 ALGOMA ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-2104
Practice Address - Country:US
Practice Address - Phone:920-982-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4580-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1952685794Medicaid
WI4580-033OtherSTATE LICENSE
WI4580-033OtherSTATE LICENSE
WIW12074017Medicare PIN
WIW12073017Medicare PIN