Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 37943 | WI |
Y | 208200000X | Surgeon | 37943 | WI |
Y | 208600000X | Surgeon | 37943 | WI |
NPI | 1326074196 |
---|---|
Provider Name | Jolene E. Andryk |
First Address | Milwaukee, WI 53209-2042 |
Second Address | Mequon, WI 53092-3388 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33345200 | (05) | WI |
H30356 | (02) | WI |
P00679656 | RR MEDICARE (01) | WI |