Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 68948 | WI |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 68948 | WI |
NPI | 1225449291 |
---|---|
Provider Name | Jenna Racine |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53715-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 21/09/2021 |