Provider Demographics
NPI:1962519579
Name:HARTLAUB, JENNIFER WOLLACH (APNP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:WOLLACH
Last Name:HARTLAUB
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:WOLLACH
Other - Last Name:TREWYN
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:945 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1305
Practice Address - Country:US
Practice Address - Phone:414-219-6000
Practice Address - Fax:414-385-5113
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI978-033363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43852600Medicaid