Healthcare Provider Details

I. General information

NPI: 1669712535
Provider Name (Legal Business Name): JACQUELYN PARADISE MSN NNP-BC APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 W CONNELL AVE
MILWAUKEE WI
53226-3067
US

IV. Provider business mailing address

8915 W CONNELL AVE
MILWAUKEE WI
53226-3067
US

V. Phone/Fax

Practice location:
  • Phone: 414-241-7583
  • Fax:
Mailing address:
  • Phone: 414-241-7583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number194720-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number8975-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: