Provider Demographics
NPI:1831962703
Name:SOHR, JENNIFER A (APNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:SOHR
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9707
Mailing Address - Country:US
Mailing Address - Phone:262-573-2719
Mailing Address - Fax:
Practice Address - Street 1:525 S SILVERBROOK DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3868
Practice Address - Country:US
Practice Address - Phone:262-365-5408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10118-33207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine