Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 4047 | WI |
N | 363LA2200X | Nurse Practitioner - Adult Health | FL ARNP 2171862 | FL |
NPI | 1013029214 |
---|---|
Provider Name | Ms. Jacquelyn Forbes Kearns |
First Address | Marshfield, WI 54449-5703 |
Second Address | Wausau, WI 54401-4129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 11/05/2010 |