Individual
MS. VICKIE L JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
W129N7055 NORTHFIELD DR, MENOMONEE FALLS, WI 53051-0538
(262) 253-5400
(262) 253-3399
Mailing address
W129N7055 NORTHFIELD DR, MENOMONEE FALLS, WI 53051-0538
(262) 253-5400
(262) 253-3399
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
799-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42950400
—
WI
Enumeration date
08/23/2006
Last updated
03/07/2023
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