Individual
MRS. JACLYNN ANN MISKULIN-BAGGESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2134 GREEN ST, RACINE, WI 53402-4569
(262) 637-3179
(262) 637-3179
Mailing address
2134 GREEN ST, RACINE, WI 53402-4569
(262) 637-3179
(262) 637-3179
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
127497030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38231000
WISCONSIN MEDICAID PROVIDER NUMBER
WI
Enumeration date
06/26/2008
Last updated
06/26/2008
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