Provider Demographics
NPI:1992050579
Name:HUNT, JACQUELINE M (PA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:HUNT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 SPRING ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1667
Mailing Address - Country:US
Mailing Address - Phone:262-687-5850
Mailing Address - Fax:262-687-5804
Practice Address - Street 1:3811 SPRING ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1667
Practice Address - Country:US
Practice Address - Phone:262-687-5850
Practice Address - Fax:262-687-5804
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2992363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical