Individual provider Active NPI

Jennifer Ann Heenan, APNP

  • Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1316234362
Registry record updated Jul 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4390-33 Issued in WI
Practice address
5320 W Michaels Dr
Appleton, WI 54913-8446
Phone
(920) 882-8200
Fax
(920) 882-8225
NPI assigned
Jun 28, 2011
Last updated
Jul 5, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4390-033 WI
Nurse Practitioner 363L00000X 4390-33 WI Primary
Registered Nurse 163W00000X 146092-30 WI

Addresses

Primary practice location

5320 W Michaels Dr
Appleton, WI 54913-8446

Mailing address

100 Theda Clark Medical PLZ
Ste 400
Neenah, WI 54956-2763
Phone (920) 725-4527

Other names 1

  • Jennifer Ann Schuld Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111011000730 WI Practitioner - Nurse Practitioner 2769654912 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Surgical Associates of Neenah, S.C.Group PAC ID 4486625258, 29 clinicians

Practice addresses (Care Compare)

100 Theda Clark Medical PLZ
Suite 400
Neenah, WI 54956-2763
Phone (920) 725-4527

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
146092-30WIMDRegistered Nurse
4390-033WIMDNurse Practitioner
4390-33WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Associates of Neenah, S.C. CurrentSince Apr 6, 2021 Accepting new patients

Locations

820 E Grant St
Ste 230
Appleton, WI 54911
Phone (920) 725-4527

100 Theda Clark Medical Plz
Neenah, WI 54956
Phone (920) 722-7747

100 Theda Clark Medical Plz
Ste 400
Neenah, WI 54956
Phone (414) 725-4527

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

902 Riverside Dr
Ste 201
Waupaca, WI 54981
Phone (715) 256-3000

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625443200000",
    "number": "1316234362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 THEDA CLARK MEDICAL PLZ",
            "address_2": "STE 400",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562763",
            "telephone_number": "920-725-4527",
            "fax_number": "920-729-2378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5320 W MICHAELS DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138446",
            "telephone_number": "920-882-8200",
            "fax_number": "920-882-8225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEENAN",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-28",
        "last_updated": "2021-07-05",
        "certification_date": "2021-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "4390-033",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "4390-33",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "146092-30",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "SCHULD",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.