Individual
JACLYN GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1312 E OKLAHOMA AVE, MILWAUKEE, WI 53207-2457
(414) 595-4570
Mailing address
1312 E OKLAHOMA AVE, MILWAUKEE, WI 53207-2457
(414) 595-4570
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7895-23
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/05/2022
Last updated
07/04/2024
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