Provider Demographics
NPI:1538123179
Name:ARBUCKLE, JACQUELYNN D (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:D
Last Name:ARBUCKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELYNN
Other - Middle Name:DAWN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5801 DAWLEY DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5801 DAWLEY DR
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7222
Practice Address - Country:US
Practice Address - Phone:608-274-6768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery