Individual
DR. SHANIQUE NASTASSJA JARRETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3003 UNIVERSITY DR, MARINETTE, WI 54143-4110
(715) 735-4200
(715) 735-8019
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
69031
WI
207Q00000X
Family Medicine Physician
OT016339
PA
208M00000X
Hospitalist Physician
Primary
69031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100079353
—
WI
Enumeration date
05/18/2015
Last updated
12/04/2024
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