Provider Demographics
NPI:1679209324
Name:RICKERT, JENNIFER B (APNP)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:B
Last Name:RICKERT
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 1:748 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-5859
Mailing Address - Country:US
Mailing Address - Phone:920-312-1287
Mailing Address - Fax:
Practice Address - Street 1:350 E SHEBOYGAN ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSPORT
Practice Address - State:WI
Practice Address - Zip Code:53010-2795
Practice Address - Country:US
Practice Address - Phone:920-533-8361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12100-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily