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NPI Code Detail

MEDICARE: MS. JODY M CHILSEN PA-C

MEDICARE: MS. JODY M CHILSEN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant701-023WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184629172
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JODY M CHILSEN PA-C
Provider Business Mailing Address
First Line : 2321 STOUT RD
Second Line :
City : MENOMONIE
State : WI
Zip : 54751-7003
Country : US
Telephone Number : 715-235-5531
Fax Number : 715-233-7645
Provider Business Practice Location Address
First Line : 2321 STOUT RD
Second Line :
City : MENOMONIE
State : WI
Zip : 54751-7003
Country : US
Telephone Number : 715-235-5531
Fax Number : 715-233-7645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 07/08/2007

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