Individual
MRS. JACKLYN SUSAN BACKHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
1050 DIVISION ST, MAUSTON, WI 53948-1931
(608) 847-6161
Mailing address
5522 E OVERLOOK CIR, WEST BEND, WI 53095-8700
(262) 483-4014
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
16067-33
WI
363LA2100X
Acute Care Nurse Practitioner
16067-33
WI
Other
Enumeration date
02/11/2025
Last updated
03/27/2025
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