Provider Demographics
NPI:1225836638
Name:WILLE, JENNA R (RN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:R
Last Name:WILLE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:R
Other - Last Name:LOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:125 WOODHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3549
Mailing Address - Country:US
Mailing Address - Phone:262-891-7880
Mailing Address - Fax:
Practice Address - Street 1:125 WOODHAVEN LN
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3549
Practice Address - Country:US
Practice Address - Phone:262-891-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI254468-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse