Provider Demographics
NPI:1992146237
Name:EVANS, JENNA ROSE (RN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ROSE
Last Name:EVANS
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BRULE RD
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-3713
Mailing Address - Country:US
Mailing Address - Phone:920-471-7577
Mailing Address - Fax:
Practice Address - Street 1:1480 NAVIGATOR WAY UNIT 46
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-7226
Practice Address - Country:US
Practice Address - Phone:920-471-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI195910-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse