Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 10742-33 | WI |
NPI | 1023601143 |
---|---|
Provider Name | Jessica Ann Pech |
First Address | Fort Atkinson, WI 53538-1233 |
Second Address | Fort Atkinson, WI 53538-1233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2021 |
Last Update Date | 07/06/2021 |