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Individual

JENNIFER R JACKAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APNP

Contact information

Practice address
2500 E CAPITOL DR, SUITE 2600, APPLETON, WI 54911-8735
(920) 739-3537
(920) 739-4115
Mailing address
2500 E CAPITOL DR, SUITE 2600, APPLETON, WI 54911-8735
(920) 739-3537
(920) 739-4115

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3460
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1225281264
WI
01
141649-030
LICENSE
WI
01
3460-033
WISCONSIN LICENSE NURSE PRACTITIONER
WI
Enumeration date
11/03/2008
Last updated
10/31/2012
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