Provider Demographics
NPI:1649895269
Name:UPHOFF, JENIFER MARY (RN)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:MARY
Last Name:UPHOFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 STARK RD
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-9776
Mailing Address - Country:US
Mailing Address - Phone:608-209-7688
Mailing Address - Fax:
Practice Address - Street 1:3181 CONSERVANCY ESTATES LN
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-9249
Practice Address - Country:US
Practice Address - Phone:608-825-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI173066163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse