Individual
JENNIFER AUTUMN MASTRANGELO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
415 BLACK EARTH RD, WALES, WI 53183-9759
(262) 893-5358
Mailing address
30412 MOUNTAIN LN, WATERFORD, WI 53185-3430
(262) 434-8588
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
161454
WI
Other
Enumeration date
11/25/2020
Last updated
11/25/2020
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