Provider Demographics
NPI:1457606121
Name:DZEMSKE, JENNIFER G (APNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:DZEMSKE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:GUENTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:2051 S 67TH PL
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-1306
Mailing Address - Country:US
Mailing Address - Phone:414-208-6933
Mailing Address - Fax:
Practice Address - Street 1:2051 S 67TH PL
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-1306
Practice Address - Country:US
Practice Address - Phone:414-208-6933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI315608-31164W00000X
WI13844363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIUNKNOWNMedicaid