Provider Demographics
NPI:1821543760
Name:FRIAR-LECAPTAIN, JACALYN (RN)
Entity Type:Individual
Prefix:
First Name:JACALYN
Middle Name:
Last Name:FRIAR-LECAPTAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 W BURRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-8681
Mailing Address - Country:US
Mailing Address - Phone:608-201-4611
Mailing Address - Fax:
Practice Address - Street 1:333 E CAMPUS MALL RM 7111
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1365
Practice Address - Country:US
Practice Address - Phone:608-265-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-21
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI87039-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse