Basic Information
| Provider Information | |||||||||
| NPI: | 1619358678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VOLM | ||||||||
| FirstName: | JAYANNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BULLMAN | ||||||||
| OtherFirstName: | JAYANNA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2401 PLOVER RD | ||||||||
| Address2: | |||||||||
| City: | PLOVER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544673916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152953800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2401 PLOVER RD | ||||||||
| Address2: | |||||||||
| City: | PLOVER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544673916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152953800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2015 | ||||||||
| LastUpdateDate: | 06/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 6362 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 6362-30 | 01 | WI | APNP LIC | OTHER | 154442-30 | 01 | WI | RN LIC | OTHER |