Individual
MR. JACOB D ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-S
Contact information
Practice address
4202 INDIAN SPRINGS DR, WAUSAU, WI 54401-4961
(715) 216-7553
Mailing address
4202 INDIAN SPRINGS DR, WAUSAU, WI 54401-4961
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
798223
WI
Other
Enumeration date
07/06/2022
Last updated
07/09/2024
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