Healthcare Provider Details

I. General information

NPI: 1376447821
Provider Name (Legal Business Name): JESSICA KNACK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 HILLCREST DR STE 105
HUDSON WI
54016-9919
US

IV. Provider business mailing address

2651 HILLCREST DR STE 105
HUDSON WI
54016-9919
US

V. Phone/Fax

Practice location:
  • Phone: 715-280-9151
  • Fax: 715-280-9152
Mailing address:
  • Phone: 715-280-9151
  • Fax: 715-280-9152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number2140751
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number1115611-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: