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General NPI Number Information
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NPI Number | 1770310377
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Entity Type | Individual
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Provider Name | JACQUELYN CATHLEEN ANDERSON DNP
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Gender | Female
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 2116 CRAIG RD
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6149
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Country | US
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Telephone | 715-858-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 515 15TH ST SE
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City | MENOMONIE
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State | WI
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Zip | 54751-2943
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Country | US
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Telephone | 715-590-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1592633
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License Number State | WI
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