Individual
JENNA MOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-2000
(414) 385-1590
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 219-2000
(414) 385-1590
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
511
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100228527
—
WI
Enumeration date
11/23/2022
Last updated
02/23/2026
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