Individual
JENNIFER LEE PRAVECHEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
555 REDBIRD CIR, SUITE 200, DE PERE, WI 54115-7977
(920) 338-6820
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
285485
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36047500
—
WI
Enumeration date
07/24/2007
Last updated
08/21/2013
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