Search › Wisconsin › 111N00000X
Jackson Detrick
NPI 1760946743 · on the registry since 2019 · sole proprietor
Practice
- Address
- 1893 Whistling Straits Dr
Altoona, WI 54720 - Phone
- (715) 828-3245
Registry record
- Primary taxonomy
- 111N00000X
111N00000X
- Licence states on file
- WI
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2019-01-24
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Wisconsin