Individual
MS. JILL KOCH WANGGAARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8400 WASHINGTON AVE, MOUNT PLEASANT, WI 53406-3735
(262) 884-4088
(262) 884-4078
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(262) 884-4088
(262) 884-4078
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
74115
WI
363LF0000X
Family Nurse Practitioner
74115-030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396734034
—
WI
Enumeration date
10/15/2005
Last updated
11/23/2021
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