Individual
JENNIFER GAYLE POLACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP-BC
Contact information
Practice address
729 PINE ST, ATHENS, WI 54411-9305
(715) 257-1686
Mailing address
W1692 FAWN AVE, RIB LAKE, WI 54470-9615
(715) 560-0193
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
11270-33
WI
Other
Enumeration date
09/07/2021
Last updated
09/07/2021
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