NPIMap

Individual provider Active NPI

Jennifer Nicole Wenninger, P.A.

  • Physician Assistant
  • Appleton, WI
National Provider Identifier
1720342348
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2935-23 Issued in WI
Practice address
3916 N Intertech CT
Appleton, WI 54913-6957
Phone
(920) 996-1000
Fax
(920) 997-8302
NPI assigned
Jun 28, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2935-23 WI Primary

Addresses

Primary practice location

3916 N Intertech CT
Appleton, WI 54913-6957

Mailing address

3916 N Intertech CT
Appleton, WI 54913-6957
Phone (920) 996-1000

Other names 1

  • Jennifer Nicole Delfosse Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121213000494 WI Practitioner - Physician Assistant 1456503770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wake Forest University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Care Associates of Appleton, LTDGroup PAC ID 1052348612, 31 clinicians

Practice addresses (Care Compare)

3916 N Intertech CT
Appleton, WI 54913-6957
Phone (920) 996-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2935-23WIMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: jdelfosse274630@direct.thedacare.org

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 12

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": "1340841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1720342348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3916 N INTERTECH CT",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549136957",
            "telephone_number": "920-996-1000",
            "fax_number": "920-997-8302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3916 N INTERTECH CT",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549136957",
            "telephone_number": "920-996-1000",
            "fax_number": "920-997-8302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENNINGER",
        "first_name": "JENNIFER",
        "middle_name": "NICOLE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-28",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2935-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "DELFOSSE",
            "middle_name": "NICOLE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.