Provider Demographics
NPI:1952339699
Name:AKERT, JACQUELINE MOORE (RNC, MSN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MOORE
Last Name:AKERT
Suffix:
Gender:F
Credentials:RNC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36500 AURORA DRIVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:SUMMIT
Mailing Address - State:WI
Mailing Address - Zip Code:53066
Mailing Address - Country:US
Mailing Address - Phone:262-434-5000
Mailing Address - Fax:
Practice Address - Street 1:36500 AURORA DRIVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SUMMIT
Practice Address - State:WI
Practice Address - Zip Code:53066
Practice Address - Country:US
Practice Address - Phone:262-434-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1080363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIS92808Medicare UPIN
WI68820Medicare ID - Type UnspecifiedMEDICARE