Provider Demographics
NPI:1386978260
Name:BAUMGART, JENNIFER LEA (APNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEA
Last Name:BAUMGART
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEA
Other - Last Name:DEGROOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:305 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-2865
Mailing Address - Country:US
Mailing Address - Phone:920-766-4656
Mailing Address - Fax:920-766-4659
Practice Address - Street 1:305 E 12TH ST
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130
Practice Address - Country:US
Practice Address - Phone:920-766-4656
Practice Address - Fax:920-766-4659
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3891-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner