Provider Demographics
NPI:1053696948
Name:PARENT, JENNIFER LYNN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:PARENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 CUTLER RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:WI
Mailing Address - Zip Code:54830-9353
Mailing Address - Country:US
Mailing Address - Phone:715-656-3024
Mailing Address - Fax:
Practice Address - Street 1:10025 CUTLER RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:WI
Practice Address - Zip Code:54830-9353
Practice Address - Country:US
Practice Address - Phone:715-656-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI313935-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse