Provider Demographics
NPI:1871155234
Name:KLAR, JENNIFER J
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:KLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S4059 OLSON DR
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-8028
Mailing Address - Country:US
Mailing Address - Phone:608-385-0391
Mailing Address - Fax:
Practice Address - Street 1:324 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1401
Practice Address - Country:US
Practice Address - Phone:608-647-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI139428163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse