Individual
JACLYN KATE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
N7770 LOYALTY RD, BLANCHARDVILLE, WI 53516-9624
(608) 214-0173
Mailing address
N7770 LOYALTY RD, BLANCHARDVILLE, WI 53516-9624
(608) 214-0173
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
191453-30
WI
164W00000X
Licensed Practical Nurse
314220031
WI
Other
Enumeration date
04/01/2012
Last updated
08/01/2012
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