Wanggaard, Jill Koch

Wanggaard, Jill Koch is an individual health care provider with primary practice located at 8400 Washington Ave , Mount Pleasant WI 53406-3735. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Wanggaard, Jill Koch can be contacted via phone (262) 884-4088.

Contact Information

Primary practice address
8400 Washington Ave Mount Pleasant WI 53406-3735
Phone: (262) 884-4088
Fax: (262) 884-4078
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 74115 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 74115-030 Wisconsin

Profile Details

NPI number 1396734034
LBN Legal business name Wanggaard, Jill Koch
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 15th, 2005
Last updated Nov 23rd, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396734034 NPPES
Wisconsin MEDICAID 1396734034

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