NPIMap

Individual provider Active NPI

Jaclynn Ann Lien-Skubal, APNP

  • Family Nurse Practitioner
  • Cudahy, WI
National Provider Identifier
1710237078
Registry record updated Feb 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4973 Issued in WI
Practice address
5900 S Lake Dr Lowr Level
Cudahy, WI 53110-3171
Phone
(414) 744-4000
Fax
(414) 489-4022
NPI assigned
Sep 13, 2012
Last updated
Feb 14, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4973-33 WI
Family Nurse Practitioner 363LF0000X 4973 WI Primary

Addresses

Primary practice location

5900 S Lake Dr Lowr Level
Cudahy, WI 53110-3171

Mailing address

5900 S Lake Dr
Cudahy, WI 53110-3171

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130930000537 WI Practitioner - Nurse Practitioner 5395979678 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pulmonary and Critical Care Associates S CGroup PAC ID 4183695737, 7 clinicians

Practice addresses (Care Compare)

10101 S 27TH St
Franklin, WI 53132-7209
Phone (414) 325-4700

5900 S Lake Dr
Cudahy, WI 53110-3171
Phone (414) 744-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4973-33WIMDNurse Practitioner
4973WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Critical Care SC CurrentSince Jan 1, 2024 Accepting new patients
Pulmonary & Critical Care Associates S C CurrentSince May 28, 2016 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Feb 2, 2019 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Feb 2, 2019 Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc Nurse Practitioner CurrentSince Jan 28, 2021 Accepting new patients
Ascension All Saints Hospital, Inc Past Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

19475 W North Ave
Brookfield, WI 53045
Phone (262) 780-4000

5900 S Lake Dr
Cudahy, WI 53110
Phone (414) 489-4055

5900 S Lake Dr
Lowr
Cudahy, WI 53110
Phone (414) 489-4072

10101 S 27th St
Franklin, WI 53132
Phone (414) 325-4700

6400 Industrial Loop
Greendale, WI 53129
Phone (414) 423-4100

10400 75th St
Kenosha, WI 53142
Phone (262) 697-7000

1001 W Glen Oaks Ln
Ste 105
Mequon, WI 53092
Phone (414) 258-8314

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

3803 Spring St
Mount Pleasant, WI 53405
Phone (262) 687-5236

791 Summit Ave
Summit, WI 53066
Phone (262) 569-0251

725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739491200000",
    "number": "1710237078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 S LAKE DR",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531103171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 S LAKE DR LOWR LEVEL",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531103171",
            "telephone_number": "414-744-4000",
            "fax_number": "414-489-4022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEN-SKUBAL",
        "first_name": "JACLYNN",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-13",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "4973-33",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "4973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cudahy, WI

Sources for this page

Verify at the official NPI Registry.