Individual
MRS. BECKY LYNN JARACZ KOHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PA-C
Contact information
Practice address
611 E SHERMAN AVE, FORT ATKINSON, WI 53538-1960
(920) 568-5330
(920) 568-5075
Mailing address
4826 ACADEMY DR, MADISON, WI 53716-1452
(608) 268-3683
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1576023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43023100
—
WI
Enumeration date
04/02/2007
Last updated
09/17/2008
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