Provider Demographics
NPI:1902123813
Name:POTTERS, JENNA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:M
Last Name:POTTERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:TAUBENHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:W225S3678 FOXCROFT LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-8008
Mailing Address - Country:US
Mailing Address - Phone:414-550-8544
Mailing Address - Fax:
Practice Address - Street 1:W225S3678 FOXCROFT LN
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-8008
Practice Address - Country:US
Practice Address - Phone:414-550-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-02
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI166446-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse