Individual
JENNY L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3750
(414) 259-9290
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3750
(414) 259-9290
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1992023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609986645
—
WI
Enumeration date
08/30/2006
Last updated
01/10/2020
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