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NPI Code Detail

MEDICARE: JACQUELYN PARADISE MSN NNP-BC APNP

MEDICARE: JACQUELYN PARADISE MSN NNP-BC APNP
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
1163W00000XRegistered Nurse194720-30WI
2363LN0000XNeonatal Nurse Practitioner8975-33WI

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 : 1669712535
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN PARADISE MSN NNP-BC APNP
Provider Business Mailing Address
First Line : 8915 W CONNELL AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-3067
Country : US
Telephone Number : 414-241-7583
Fax Number :
Provider Business Practice Location Address
First Line : 8915 W CONNELL AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-3067
Country : US
Telephone Number : 414-241-7583
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2013
Last Update Date : 05/02/2024

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