Basic Information
Provider Information | |||||||||
NPI: | 1073932349 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WOZNICK | ||||||||
FirstName: | JESSICA | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BIGLER | ||||||||
OtherFirstName: | JESSICA | ||||||||
OtherMiddleName: | LYNN | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 7901 S 6TH ST | ||||||||
Address2: |   | ||||||||
City: | OAK CREEK | ||||||||
State: | WI | ||||||||
PostalCode: | 531542010 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4143468000 | ||||||||
FaxNumber: | 4143468010 | ||||||||
Practice Location | |||||||||
Address1: | 7901 S 6TH ST | ||||||||
Address2: |   | ||||||||
City: | OAK CREEK | ||||||||
State: | WI | ||||||||
PostalCode: | 531542010 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4143468000 | ||||||||
FaxNumber: | 4143468010 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/15/2014 | ||||||||
LastUpdateDate: | 09/26/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.131009 | OH | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 70650-20 | WI | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.