Most Relevant Information
Provider Data
| NPI Number: | 1003456823 |
| Provider Name: | JACQUELINE ANN OTS PENDING |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 10085 |
Most Important Dates
| Enumeration Date: | 01/09/2020 |
| Last Updated: | 07/11/2023 |
Provider Practice Location
855 N WESTHAVEN DR
OSHKOSH
WI
549047668
Practice Location Phone/Fax
| Phone: | 9203038700 |
| Fax: |
Provider Mailing Location
PO BOX 735044
CHICAGO
IL
606735044
Provider Mailing Phone/Fax
| Phone: | 9203038700 |
| Fax: |