Individual
JENNIFER GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3666
Mailing address
18600 BROOKFIELD LAKE DR UNIT 58, BROOKFIELD, WI 53045-6174
(630) 818-0518
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
179254-030
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
9605
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100093299
—
WI
Enumeration date
06/10/2019
Last updated
07/25/2024
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