Individual
MS. JACQUELINE A STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
12500 AURORA DR, PLEASANT PRAIRIE, WI 53158-1227
(262) 857-5000
(262) 857-5001
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
6437
WI
363LP0200X
Pediatric Nurse Practitioner
6437
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
1999139490
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100046653
—
WI
Enumeration date
12/26/2006
Last updated
08/28/2024
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