Healthcare Provider Details

I. General information

NPI: 1952779712
Provider Name (Legal Business Name): JACQUELINE N HALE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE N KORINEK PA-C

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 AURORA DR
SUMMIT WI
53066-4899
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-434-5000
  • Fax: 262-434-5850
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3655-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: