Individual
MR. MARC S JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
855 N WESTHAVEN DR, OSHKOSH, WI 54904
(920) 303-8700
(920) 303-8801
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1551-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41986800
—
WI
Enumeration date
08/18/2005
Last updated
04/01/2024
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