Jeremiah Ennen
Individual provider Active NPI Certified Registered Nurse Anesthetist · Neenah, WI
NPI 1497575260 · NPPES record last updated Jul 8, 2026
Key facts
- NPI
- 1497575260
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 1104464 (WI)
- Practice address
- 1041 Honeysuckle LN
Neenah, WI 54956-3930 - Phone
- (507) 514-2056
- NPI assigned
- Oct 15, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2026
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Minneapolis, MN 55486
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1104464 | WI | MD | Continuing Education/Staff Development Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 1104464 | WI | Yes |
| Continuing Education/Staff Development Registered Nurse | 163WC1600X | 1104464 | WI |
Addresses
Primary practice location
1041 Honeysuckle LN
Neenah, WI 54956-3930
Mailing address
PO Box 860912
Minneapolis, MN 55486-0912
Phone (715) 838-5222
Other practice location 1
1400 Bellinger St
Eau Claire, WI 54703-5222
Phone (715) 838-5222
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jennen517172@ehrdirect.mayoclinicmsg.org |
Other providers in Neenah, WI
- James R Eike
- Justin Eisberner
- Erik A Emaus
- Emerald Ridge Assisted Living, LLC
- Empowerment Living Services
- Carrie Ann Erdmann
- Jenna Erickson
- Olivia Ertmer
- Jill K Eschenbauch
- Esprit Counseling & Consulting
All providers in Neenah, WI · Certified Registered Nurse Anesthetist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.