Provider Demographics
NPI:1336523588
Name:KELLNER, JENNIFER D (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:KELLNER
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 1:6510 LAWNDALE ST
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-3943
Mailing Address - Country:US
Mailing Address - Phone:715-571-2231
Mailing Address - Fax:
Practice Address - Street 1:6510 LAWNDALE ST
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-3943
Practice Address - Country:US
Practice Address - Phone:715-571-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22330230163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse