Healthcare Provider Details

I. General information

NPI: 1922282813
Provider Name (Legal Business Name): JACLYN M AYERS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACLYN M NONN PA

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 NOBEL DR
FITCHBURG WI
53711-4955
US

IV. Provider business mailing address

PO BOX 74008272
CHICAGO IL
60674-8272
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax:
Mailing address:
  • Phone: 702-899-0595
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2224-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: