Provider Demographics
NPI:1437488517
Name:APPLEGATE, JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:APPLEGATE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5930
Mailing Address - Country:US
Mailing Address - Phone:608-245-3133
Mailing Address - Fax:608-245-3875
Practice Address - Street 1:1617 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5930
Practice Address - Country:US
Practice Address - Phone:608-245-3133
Practice Address - Fax:608-245-3875
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2532-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
68015-0135Medicare PIN
02120-2134Medicare PIN