Doctor Name: | MRS. THERESE L. JAECKLE |
NPI Number: | 1063696516 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN, APNP |
License Number: | 3319-033 |
Business Practice Address: | W62n248 Washington Ave Cedarburg, WI - 530122768 |
Business Phone Number: | 2623751116 |
Business Fax Number: | |
Mailing Address: | 4670 N 143rd St, BROOKFIELD |
State: | WI |
Postal Code: | 530051664 |
Phone Number: | 2627810297 |
Fax Number: | |
NPI Enumeration Date: | 12/19/2007 |
NPI Last Update Date: | 02/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 3319-033 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |