Provider Demographics
NPI:1285940114
Name:BATTISTINE, JENNIFER ANN (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:BATTISTINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 N NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-2864
Mailing Address - Country:US
Mailing Address - Phone:920-251-9196
Mailing Address - Fax:
Practice Address - Street 1:342 N NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-2864
Practice Address - Country:US
Practice Address - Phone:920-251-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174227163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse