Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 8754 | WI |
NPI | 1053886465 |
---|---|
Provider Name | Elizabeth A Jarecki |
First Address | Brookfield, WI 53005-7612 |
Second Address | Brookfield, WI 53005-7612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2018 |
Last Update Date | 11/10/2018 |