Individual
MS. JENNIFER JANE MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
300 N COMMERCIAL ST, SUITE 200, NEENAH, WI 54956-2619
(920) 886-0818
(920) 886-0773
Mailing address
670 CORMIER RD, GREEN BAY, WI 54304-4824
(920) 494-9685
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1908
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42875200
—
WI
Enumeration date
05/15/2006
Last updated
02/26/2020
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