Provider Demographics
NPI:1780326702
Name:O'LENA, JILL (RN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:O'LENA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:JILL
Other - Last Name:O'LENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2146 CELTIC CT
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-9711
Mailing Address - Country:US
Mailing Address - Phone:414-640-1909
Mailing Address - Fax:
Practice Address - Street 1:N74W12501 LEATHERWOOD CT
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4490
Practice Address - Country:US
Practice Address - Phone:414-777-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI103405-30163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator