Individual
MISS JACQUELINE ROSE ZDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085-004090
IL
363AS0400X
Surgical Physician Assistant
2832-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003194796
—
WI
Enumeration date
07/28/2011
Last updated
02/22/2012
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