Provider Demographics
NPI:1134607781
Name:JAMGOCHIAN, JESSIKA JEAN
Entity type:Individual
Prefix:
First Name:JESSIKA
Middle Name:JEAN
Last Name:JAMGOCHIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSIKA
Other - Middle Name:JEAN MARGERITE
Other - Last Name:SPRINGER, BARBIER, RADTKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:333 PINE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4187
Mailing Address - Country:US
Mailing Address - Phone:715-847-2021
Mailing Address - Fax:
Practice Address - Street 1:333 PINE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4187
Practice Address - Country:US
Practice Address - Phone:715-847-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8472-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner