Provider Demographics
NPI:1962457531
Name:STEVENS, JENNIFER F (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:F
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53531-9455
Mailing Address - Country:US
Mailing Address - Phone:608-764-5487
Mailing Address - Fax:608-764-2199
Practice Address - Street 1:103 LAKE ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:WI
Practice Address - Zip Code:53531-9455
Practice Address - Country:US
Practice Address - Phone:608-764-5487
Practice Address - Fax:608-764-2199
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39209-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1962457531Medicaid
WI32385800Medicaid
WI054574150Medicare PIN
WI32385800Medicaid
WI7004OtherDEAN HEALTH INSURANCE