Provider Demographics
NPI: | 1932377991 |
---|---|
Name: | NEUBAUER, JENNIFER A (APNP) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | JENNIFER |
Middle Name: | A |
Last Name: | NEUBAUER |
Suffix: | |
Gender: | F |
Credentials: | APNP |
Other - Prefix: | MS |
Other - First Name: | JENNIFER |
Other - Middle Name: | A |
Other - Last Name: | EVANS |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | APNP |
Mailing Address - Street 1: | 1 NORTHWESTERN MUTUAL WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | FRANKLIN |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53132-9497 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 414-661-8400 |
Mailing Address - Fax: | 414-661-5730 |
Practice Address - Street 1: | 1 NORTHWESTERN MUTUAL WAY |
Practice Address - Street 2: | |
Practice Address - City: | FRANKLIN |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53132-9497 |
Practice Address - Country: | US |
Practice Address - Phone: | 414-661-8400 |
Practice Address - Fax: | 414-661-5730 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-02-13 |
Last Update Date: | 2017-04-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 3306 | 363LF0000X |
WI | 141143 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WI | 1932377991 | Medicaid | |
WI | 1117 73-601 | Medicare PIN | |
WI | K400212712 | Medicare PIN |