Provider Demographics
NPI:1952779712
Name:HALE, JACQUELINE N (PA-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:N
Last Name:HALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:N
Other - Last Name:KORINEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2514 S 102ND ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2142
Mailing Address - Country:US
Mailing Address - Phone:414-259-8917
Mailing Address - Fax:414-777-5210
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PKWY STE 413
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3660
Practice Address - Country:US
Practice Address - Phone:414-383-7744
Practice Address - Fax:414-383-8089
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3655-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant