Individual
DR. JACQUELYN F DINUSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1350 S SUNNY SLOPE RD, SUNNYSLOPE PRIMARY CARE CLINIC, BROOKFIELD, WI 53005-7025
(414) 805-9600
(414) 805-9659
Mailing address
1350 S SUNNY SLOPE RD, SUNNYSLOPE PRIMARY CARE CLINIC, BROOKFIELD, WI 53005-7025
(414) 805-9600
(414) 805-9659
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
43683
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005806261S
HUMANA
—
05
—
34151400
—
WI
Enumeration date
05/13/2006
Last updated
06/27/2012
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