Individual
JENNIFER BIRDSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
225 CHURCH ST, STOUGHTON, WI 53589-1801
(608) 877-2777
(608) 877-2774
Mailing address
225 CHURCH ST, STOUGHTON, WI 53589-1801
(608) 877-2777
(608) 877-2774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4680
WI
363AM0700X
Medical Physician Assistant
4680-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225697766
—
WI
Enumeration date
06/09/2019
Last updated
08/04/2022
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