Healthcare Provider Details

I. General information

NPI: 1134813751
Provider Name (Legal Business Name): CAMRIN JADE DRESSEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13133 N PORT WASHINGTON RD STE G-18
MEQUON WI
53097-2420
US

IV. Provider business mailing address

323 HARTWOOD LN
HARTLAND WI
53029-2407
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7403-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: