Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 9942-33 | WI |
NPI | 1114552080 |
---|---|
Provider Name | Jessica Mcdonald |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Neenah, WI 54956-2883 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2020 |
Last Update Date | 11/06/2020 |