Provider Demographics
NPI:1477206811
Name:THOHAN, JEANNE (PA)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:THOHAN
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 1:11432 N JUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-2784
Mailing Address - Country:US
Mailing Address - Phone:262-518-0385
Mailing Address - Fax:
Practice Address - Street 1:4800 W GREEN BROOK DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-2406
Practice Address - Country:US
Practice Address - Phone:414-371-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5050-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant