Individual
MRS. JESSICA M WACHTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
509 HAMACHER STREET, SUITE 102, WATERLOO, IL 62298
(618) 939-3939
(618) 939-3941
Mailing address
509 HAMACHER STREET, SUITE 102, WATERLOO, IL 62298
(618) 939-3939
(618) 939-3941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085002375
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
546390
MEDICARE-ID-UNSPEC.
—
Enumeration date
11/21/2005
Last updated
05/09/2017
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