Individual
MELISSA E JENNERJOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6484
Mailing address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6484
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2077-23
WI
363AM0700X
Medical Physician Assistant
2077-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427122902
—
WI
Enumeration date
11/17/2006
Last updated
04/07/2021
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