Individual
JENNIFER DIANE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
725 AMERICAN AVENUE, WAUKESHA, WI 53188
(212) 928-8800
(262) 928-0648
Mailing address
27431 N. LAKE DRIVE, WATERFORD, WI 53185
(608) 358-8449
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
171464-30
WI
363L00000X
Nurse Practitioner
6088-33
WI
363LF0000X
Family Nurse Practitioner
Primary
6088-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100041913
—
WI
Enumeration date
10/27/2014
Last updated
12/12/2024
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