Individual
JEAN BAGIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
N14W23900 STONE RIDGE DR, PROHEALTH CARE MEDICAL ASSOCIATES INC., WAUKESHA, WI 53188-1135
(262) 574-8000
Mailing address
N14W23900 STONE RIDGE DR, PROHEALTH CARE MEDICAL ASSOCIATES INC., WAUKESHA, WI 53188-1135
(262) 574-8000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1728
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43937600
—
WI
Enumeration date
03/23/2006
Last updated
07/25/2012
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