Individual
DR. JACLYN VANDERWAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8701 W WATERTOWN PLANK RD, MILWAUKEE, WI 53226-3548
(414) 955-1833
Mailing address
8701 W WATERTOWN PLANK RD, MILWAUKEE, WI 53226-3548
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003443102
—
WI
Enumeration date
03/26/2020
Last updated
06/19/2025
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