Healthcare Provider Details

I. General information

NPI: 1265318786
Provider Name (Legal Business Name): JORDAN MARGARET DAHLHAUSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARK ST STE A
MADISON WI
53715-1830
US

IV. Provider business mailing address

4203 SUNSET RDG
COTTAGE GROVE WI
53527-9664
US

V. Phone/Fax

Practice location:
  • Phone: 608-260-2900
  • Fax: 608-260-3444
Mailing address:
  • Phone: 608-772-7869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8508-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: