Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 238888 | WI |
NPI | 1083209035 |
---|---|
Provider Name | Jennifer Lynn Leonard |
First Address | Milwaukee, WI 53213-2145 |
Second Address | Milwaukee, WI 53212-2709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2021 |
Last Update Date | 05/03/2021 |