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Individual
JACQUELINE BLANK
Active
Individual
JACQUELINE BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
64645
WI
2086S0102X
Surgical Critical Care Physician
64645
WI
2086S0127X
Trauma Surgery Physician
Primary
64645
WI
Other
Enumeration date
04/01/2014
Last updated
08/03/2023
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