Individual
JACOB R WARRENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
964 W RYAN ST, SUITE B, BRILLION, WI 54110-1517
(920) 756-2055
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1117090
NCCPA
—
Enumeration date
01/14/2014
Last updated
07/11/2023
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