Jaclyn Green
Physician Assistant in Milwaukee, WI. Individual provider (NPI-1).
NPI number1114650413
StatusActive
Last updated in NPPESJul 4, 2024
Details
- NPI
- 1114650413
- Entity type
- Individual (NPI-1)
- Name
- Jaclyn Green
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jul 5, 2022
- Certification date
- Jul 4, 2024
- Last updated
- Jul 4, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 7895-23 | WI | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
1312 E Oklahoma AveMilwaukee, WI 53207-2457
Phone 414-595-4570
Mailing address
1312 E Oklahoma AveMilwaukee, WI 53207-2457
Phone 414-595-4570
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