Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 36739 | WI |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 36739 | WY |
N | 207RH0002X | Hospice and Palliative Medicine | 36739 | WI |
NPI | 1619081080 |
---|---|
Provider Name | Timothy J Jessick |
First Address | Neenah, WI 54956-3070 |
Second Address | Appleton, WI 54915-1408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 15/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100003391 | (05) | WI |