Individual
MS. BRIANNA SHANICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2555 N MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-2709
(414) 372-8080
(414) 562-8084
Mailing address
2555 N DR MARTIN LUTHER KING JR DR, MILWAUKEE, WI 53212-2709
(414) 372-8080
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5587-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100180686
—
WI
Enumeration date
07/06/2021
Last updated
07/03/2024
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