Healthcare Provider Details

I. General information

NPI: 1114997335
Provider Name (Legal Business Name): JEANINE THUROW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W9183 BLUE SPRUCE LN
CAMBRIDGE WI
53523-8801
US

IV. Provider business mailing address

W9183 BLUE SPRUCE LN
CAMBRIDGE WI
53523-8801
US

V. Phone/Fax

Practice location:
  • Phone: 608-516-0568
  • Fax:
Mailing address:
  • Phone: 608-516-0568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number503-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: