Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lacey L Jandrin, PA-C

Individual provider Occupational Therapist · NPI 1104183516

Lacey L Jandrin, PA-C is a Physician Assistant in Green Bay, Wisconsin. Graduated from University of North Dakota School of Medicine in 2016, 10 years ago. Practices with Bellin Memorial Hospital Inc, a 681-clinician group, works from 5 locations and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
10
Trained at
University of North Dakota School of Medicine
Licensed in
WI
In the registry since
2012
Specialties on file
3
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1970 S Ridge Rd
Green Bay, WI 54304-4125
Phone: (920) 430-4888
Fax: (920) 430-4889
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (4)

  • 1160 Kepler Dr, Green Bay, WI 54311-8321 — (920) 288-5555
  • 3415 Custer St Ste D, Manitowoc, WI 54220-4328 — (920) 652-9310
  • 2820 Roosevelt Rd, Marinette, WI 54143-3834 — (715) 735-5225
  • 820 Arbutus Ave, Oconto, WI 54153-2004 — (920) 835-1100

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 3761-23 (WI)
Occupational Therapist Taxonomy 225X00000X · Licence 4712 (WI)
Physician Assistant Taxonomy 363A00000X · Licence 1135070 (WI)

Record details

NPI number1104183516
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedApril 23, 2012
Last updated in NPPESJanuary 30, 2023
Certification dateJanuary 30, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolUNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE
Graduated 2016 (10 years in practice)
Group practice Bellin Memorial Hospital Inc — 681 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Green Bay