Healthcare Provider Details

I. General information

NPI: 1578264065
Provider Name (Legal Business Name): JACLYN ELIZABETH ALLEN DNP, RN, ACCNS-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 W CONNELL COURT
MILWAUKEE WI
53226
US

IV. Provider business mailing address

2422 COOLIDGE STREET
MADISON WI
53704
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2000
  • Fax:
Mailing address:
  • Phone: 262-993-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number2000396302
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number198000
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: