Provider Demographics
NPI:1801646245
Name:DAGGETT, JENNIFER ANN (APNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:DAGGETT
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2850 STATE ROAD 28
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-2702
Mailing Address - Country:US
Mailing Address - Phone:920-467-1800
Mailing Address - Fax:920-467-1900
Practice Address - Street 1:W2850 STATE ROAD 28
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-2702
Practice Address - Country:US
Practice Address - Phone:920-467-1800
Practice Address - Fax:920-467-1900
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15201-33363LF0000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100274215Medicaid