Individual
JENNIFER A DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
160 GATEWAY DR, WAUPUN, WI 53963-2276
(920) 324-9899
Mailing address
160 GATEWAY DR, WAUPUN, WI 53963-2276
(920) 324-9899
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
7769
WI
363LG0600X
Gerontology Nurse Practitioner
Primary
7769
WI
Other
Enumeration date
07/20/2017
Last updated
10/10/2023
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