Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 8831884-1205 | UT |
NPI | 1003170127 |
---|---|
Provider Name | Carina M Jackman |
First Address | Milwaukee, WI 53210-1650 |
Second Address | Milwaukee, WI 53210-1650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2012 |
Last Update Date | 21/10/2021 |