| Doctor Name: | MRS. JENNIFER MLADUCKY |
| NPI Number: | 1003941956 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 1049 |
| Business Practice Address: | 2700 W 9th Ave Suite 11 Oshkosh, WI - 549047247 |
| Business Phone Number: | 9202361555 |
| Business Fax Number: | |
| Mailing Address: | 900 E Grant St, APPLETON |
| State: | WI |
| Postal Code: | 549113487 |
| Phone Number: | 9207491171 |
| Fax Number: | |
| NPI Enumeration Date: | 02/22/2007 |
| NPI Last Update Date: | 04/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 1049 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |