Individual
MR. JEFFREY VAN RICHARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2502 S ASHLAND AVE, GREEN BAY, WI 54304-5252
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1815
MN
363A00000X
Physician Assistant
Primary
4288-23
WI
Other
Enumeration date
09/26/2012
Last updated
02/09/2023
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