Provider Demographics
NPI:1992427686
Name:SONNENTAG, JENNIFER M
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:SONNENTAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MATHIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 E MILESTONE DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-6701
Mailing Address - Country:US
Mailing Address - Phone:920-731-8131
Mailing Address - Fax:920-832-0444
Practice Address - Street 1:2000 E MILESTONE DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-6701
Practice Address - Country:US
Practice Address - Phone:920-731-8131
Practice Address - Fax:920-832-0444
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12144363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner