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DR. JACLYN VANDERWAL MD
NPI 1003443102
Student in an Organized Health Care Education/Training Program in Milwaukee, WI

Active since March 26, 2020PECOS Enrolled
8701 W WATERTOWN PLANK RD, MILWAUKEE, WI 53226(414) 955-1833 Get Directions Write a Review

NPPES record last updated: June 19, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 19, 2025, Mar 26, 2020 (2 updates tracked since 2020).

About Dr. Jaclyn Vanderwal Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACLYN VANDERWAL MD (NPI 1003443102) is an individual student in an organized health care education/training program in Milwaukee, Wisconsin and active in the NPI registry since March 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1003443102
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameDR. JACLYN VANDERWALCredential: MD
Location Address8701 W WATERTOWN PLANK RDMilwaukee, WI 53226-3548
Mailing Address8701 W Watertown Plank RdMilwaukee, WI 53226-3548
Phone(414) 955-1833
Sole ProprietorNo
Enumeration DateMarch 26, 2020
Last NPPES UpdateJune 19, 20252 updates tracked since enumeration
NPPES CertifiedJune 19, 2025
✔ NPI 1003443102 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
8701 W WATERTOWN PLANK RD, Milwaukee, WI 53226
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Other Identifiers 1

Medicaid1003443102WI

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jaclyn Vanderwal Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JAMES VAUGHAN M.D.
Pathology (Anatomic Pathology & Clinical Pathology)
8701 W WATERTOWN PLANK RD
MILWAUKEE, WI 53226
Milwaukee County (414) 456-8296
DR. KEONA CHILDS M.D.
Emergency Medicine
8701 W WATERTOWN PLANK RD, MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS
MILWAUKEE, WI 53226
Milwaukee County (414) 955-4575
SAMIH THALJI
Student in an Organized Health Care Education/Training Program
8701 W WATERTOWN PLANK RD
MILWAUKEE, WI 53226
Milwaukee County (414) 955-4575
JAMES BENJAMIN MORONEY MD
Radiology (Vascular & Interventional Radiology)
8701 W WATERTOWN PLANK RD
MILWAUKEE, WI 53226
Milwaukee County (414) 456-6800
JORDAN ROBERT HANRAHAN
Student in an Organized Health Care Education/Training Program
8701 W WATERTOWN PLANK RD
MILWAUKEE, WI 53226
Milwaukee County (414) 955-4582
VERONICA QUINTERN PUJOL MD
Internal Medicine
8701 W WATERTOWN PLANK RD
MILWAUKEE, WI 53226
Milwaukee County (414) 955-8218
SARAH J LECAPITAINE MD
Student in an Organized Health Care Education/Training Program
8701 W WATERTOWN PLANK RD
WAUWATOSA, WI 53226
Milwaukee County (414) 955-8296
MRIGANK SHEKHAR GUPTA MD
Internal Medicine (Critical Care Medicine)
8701 W WATERTOWN PLANK RD
MILWAUKEE, WI 53226
Milwaukee County (414) 955-4578

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jaclyn Vanderwal's NPI number?

The NPI number for Jaclyn Vanderwal is 1003443102. It was assigned to this individual provider in the NPPES registry on March 26, 2020.

Where is Jaclyn Vanderwal located?

Jaclyn Vanderwal practices at 8701 W Watertown Plank Rd, Milwaukee, WI 53226. The listed phone number is (414) 955-1833.

What is Jaclyn Vanderwal's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jaclyn Vanderwal enrolled in Medicare?

Yes. Jaclyn Vanderwal is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jaclyn Vanderwal was last updated on June 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.