Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 63096-20 | WI |
Y | 208600000X | Surgeon | 63096-20 | WI |
N | 2086S0105X | Surgery of the Hand | 67211 | MN |
NPI | 1518200831 |
---|---|
Provider Name | Jacqueline Susan Israel |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2013 |
Last Update Date | 16/12/2021 |