Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 42630-20 | WI |
N | 2080P0204X | Pediatric Emergency Doctor | 42630 | WI |
NPI | 1003867409 |
---|---|
Provider Name | Dr. Jennifer M Chevalier |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Brookfield, WI 53005-2441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 09/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003867409 | (05) | WI |
H76338 | (02) |