Individual
JENNIFER BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
601 S CENTER AVE, MERRILL, WI 54452-3404
(715) 536-5511
Mailing address
411 WESTWOOD DR, WAUSAU, WI 54401-4152
(715) 847-2558
(715) 847-2557
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1910
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1910
WI STATE LIC
WI
Enumeration date
06/08/2006
Last updated
04/20/2017
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