Individual
LAURA JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4200 SAVANNAH DR, MERITER DEFOREST-WINDSOR, DEFOREST, WI 53562
(608) 414-3300
(608) 417-3100
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
55905
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336335686
—
WI
Enumeration date
09/20/2007
Last updated
02/01/2021
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