Provider Demographics
NPI:1245871425
Name:MURRAY, JENNIFER LYNN (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10256 OLD GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-2814
Mailing Address - Country:US
Mailing Address - Phone:262-551-4200
Mailing Address - Fax:262-551-4947
Practice Address - Street 1:10256 OLD GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-2814
Practice Address - Country:US
Practice Address - Phone:262-551-4200
Practice Address - Fax:262-551-4947
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041413649163W00000X
WI24062930163W00000X
IL209020321363LF0000X
WI969033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1245871425Medicaid
WI9690-33OtherWI APNP LICENSE