1790334373 NPI number — MISS JEANINE ANN NOFFKE FAMILY NURSE PRACTIC

Table of content: MISS JEANINE ANN NOFFKE FAMILY NURSE PRACTIC (NPI 1790334373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790334373 NPI number — MISS JEANINE ANN NOFFKE FAMILY NURSE PRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOFFKE
Provider First Name:
JEANINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
FAMILY NURSE PRACTIC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ASHBECK
Provider Other First Name:
JEANINE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790334373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2275 N SHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RHINELANDER
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54501-8360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-361-5482
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2275 N SHORE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RHINELANDER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-361-5482
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  33-9512 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0106X , with the licence number: 33-9512 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)