Provider Demographics
NPI:1750376091
Name:HOWELL, JACQUELINE C (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:C
Last Name:HOWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:C
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2500 W SILVER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-4218
Mailing Address - Country:US
Mailing Address - Phone:414-393-1925
Mailing Address - Fax:414-393-1926
Practice Address - Street 1:2500 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-4218
Practice Address - Country:US
Practice Address - Phone:414-393-1925
Practice Address - Fax:414-393-1926
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13696208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30969400Medicaid
WI01750Medicare ID - Type Unspecified
WIF07686Medicare UPIN