Phillips, Jacquelyn Renee

Phillips, Jacquelyn Renee is an individual health care provider with primary practice located at 744 S Webster Ave 2Nd Floor, Green Bay WI 54301-3505. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Phillips, Jacquelyn Renee can be contacted via phone (920) 433-3640.

Contact Information

Primary practice address
744 S Webster Ave 2Nd Floor Green Bay WI 54301-3505
Phone: (920) 433-3640
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 1948-023 Wisconsin

Profile Details

NPI number 1609826171
LBN Legal business name Phillips, Jacquelyn Renee
Credentials APNP
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated Dec 15th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609826171 NPPES
Wisconsin MEDICAID 42881800

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