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Individual

ANTOINETTE J ANKENBRANDT

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
707 14TH ST, BARABOO, WI 53913-1539
(608) 356-1400
Mailing address
707 14TH ST, BARABOO, WI 53913-1539
(608) 356-1400

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
368
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1009390
PHYS PLUS PROV #
WI
05
42958700
WI
01
70
DC PROV #
WI
01
P00215997
RR MEDICARE PROV #
WI
Enumeration date
04/11/2006
Last updated
07/09/2007
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