Individual
JACOB JAY DAWSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
5120 STETTIN DR, WAUSAU, WI 54401-3824
(715) 551-6827
Mailing address
115 S 6TH AVE, WAUSAU, WI 54401-4516
(715) 401-1840
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
324142
WI
Other
Enumeration date
09/17/2019
Last updated
09/17/2019
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