Jennifer Michele Gates

Individual provider Active NPI Licensed Practical Nurse · Ixonia, WI

NPI 1376956367 · NPPES record last updated Jun 6, 2014

Key facts

NPI
1376956367
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
318264-31 (WI)
Practice address
W2093 Gary LN
Ixonia, WI 53036-9724
Phone
(920) 253-5625
NPI assigned
Jun 6, 2014
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
318264-31WIMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 318264-31 WI Yes

Addresses

Primary practice location

W2093 Gary LN
Ixonia, WI 53036-9724

Mailing address

W2093 Gary LN
Ixonia, WI 53036-9724
Phone (920) 253-5625

Other names

  • Miss Jennifer Michele Krueger Former name

Other providers in Ixonia, WI

All providers in Ixonia, WI · Licensed Practical Nurse in Wisconsin

Sources for this page

Verify at the official NPI Registry.