Individual
JENNIFER SCIDMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3801 SPRING ST, RACINE, WI 53405
(262) 687-4011
Mailing address
3760 N FREMONT ST, CHICAGO, IL 60613-3927
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
54369
CA
363AM0700X
Medical Physician Assistant
3698-23
WI
363L00000X
Nurse Practitioner
3698-23
WI
Other
Enumeration date
11/30/2015
Last updated
06/26/2021
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