Provider Demographics
NPI:1831530583
Name:LEE, JENNIFER J (APNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:BRANDENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:4131 W LOOMIS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2057
Mailing Address - Country:US
Mailing Address - Phone:414-325-7246
Mailing Address - Fax:414-325-3770
Practice Address - Street 1:4131 W LOOMIS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2057
Practice Address - Country:US
Practice Address - Phone:414-325-7246
Practice Address - Fax:414-325-3770
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164569-30163W00000X
WI5335-33363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1538152491Medicaid