Provider Demographics
NPI:1538714324
Name:MCLEOD, JENNIFER N (APNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:APNP, FNP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:327 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1719
Mailing Address - Country:US
Mailing Address - Phone:262-424-0180
Mailing Address - Fax:
Practice Address - Street 1:327 NORTH AVE
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-1719
Practice Address - Country:US
Practice Address - Phone:262-369-4391
Practice Address - Fax:262-369-4392
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI193868163WG0600X, 163W00000X
WI9809363LP2300X
WI9809-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty