Basic Information
| Provider Information | |||||||||
| NPI: | 1841242443 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONNER | ||||||||
| FirstName: | JEANNE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4855 S MOORLAND RD | ||||||||
| Address2: | ALLERGY AND IMMUNOLOGY | ||||||||
| City: | NEW BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531517494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2624327703 | ||||||||
| FaxNumber: | 2624327798 | ||||||||
| Practice Location | |||||||||
| Address1: | 4855 S MOORLAND RD | ||||||||
| Address2: | ALLERGY AND IMMUNOLOGY | ||||||||
| City: | NEW BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531517494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2624327703 | ||||||||
| FaxNumber: | 2624327798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 03/13/2013 | ||||||||
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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 | 363LP0200X | 219 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000030377E | 01 | HUMANA | OTHER | 1841242443 | 05 | WI | MEDICAID |