Individual
MATT JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
W180N8085 TOWN HALL RD, MENOMONEE FALLS, WI 53051-3518
(262) 257-5100
(262) 518-5052
Mailing address
W180N8085 TOWN HALL RD, MENOMONEE FALLS, WI 53051-3518
(262) 257-5100
(262) 518-5052
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
554-17
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100281630
—
WI
Enumeration date
12/15/2021
Last updated
08/15/2024
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