Individual
SHANNON JACKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 384-1555
Mailing address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 384-1555
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
16053-33
WI
Other
Enumeration date
01/04/2024
Last updated
01/13/2025
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