Individual
MRS. JENELL DIANE JACKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
4006 WASHINGTON RD, KENOSHA, WI 53144-4819
(262) 656-0044
Mailing address
316 BUCK TRL, TWIN LAKES, WI 53181-9637
(262) 914-1433
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.389592
IL
163W00000X
Registered Nurse
163094-030
WI
363LP0200X
Pediatric Nurse Practitioner
Primary
12260-33
WI
363LP0200X
Pediatric Nurse Practitioner
209.010138
IL
Other
Enumeration date
11/30/2010
Last updated
09/07/2023
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