Healthcare Provider Details

I. General information

NPI: 1659203594
Provider Name (Legal Business Name): JESSICA SAMPOLINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA BRADLEY

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BRADLEY ST
FALL RIVER WI
53932-8802
US

IV. Provider business mailing address

119 LAZY LAKE DR
FALL RIVER WI
53932-1001
US

V. Phone/Fax

Practice location:
  • Phone: 920-484-3333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number189741-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: