Provider Demographics
NPI:1699066118
Name:WEBSTER, JACLYN JOY (RN, BSN)
Entity type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:JOY
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MISS
Other - First Name:JACLYN
Other - Middle Name:JOY
Other - Last Name:GONSIOREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:1007 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:GENOA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53128-1995
Mailing Address - Country:US
Mailing Address - Phone:262-227-3191
Mailing Address - Fax:
Practice Address - Street 1:1007 MALLARD LN
Practice Address - Street 2:
Practice Address - City:GENOA CITY
Practice Address - State:WI
Practice Address - Zip Code:53128-1995
Practice Address - Country:US
Practice Address - Phone:262-227-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI177049030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse