Provider Demographics
NPI:1700228764
Name:VERGIESEN, JAMMIE LEE (DVM)
Entity Type:Individual
Prefix:DR
First Name:JAMMIE
Middle Name:LEE
Last Name:VERGIESEN
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:DR
Other - First Name:JAMMIE
Other - Middle Name:LEE
Other - Last Name:VERSTOPPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DVM
Mailing Address - Street 1:725 WOODLAND PLZ
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:WI
Mailing Address - Zip Code:54165-1660
Mailing Address - Country:US
Mailing Address - Phone:192-050-4413
Mailing Address - Fax:192-050-4413
Practice Address - Street 1:725 WOODLAND PLZ
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:WI
Practice Address - Zip Code:54165-1660
Practice Address - Country:US
Practice Address - Phone:192-050-4413
Practice Address - Fax:192-050-4413
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6213-050174M00000X
WI408651174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174M00000XOther Service ProvidersVeterinarian
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIFV4449624OtherDEA REGISTRATION