1235228586 NPI number — MS. JANE MARIE MOKER MS

Table of content: MS. JANE MARIE MOKER MS (NPI 1235228586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235228586 NPI number — MS. JANE MARIE MOKER MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOKER
Provider First Name:
JANE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SKOWLUND
Provider Other First Name:
JANE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235228586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MARINETTE COUNTY HEALTH AND HUMAN SERVICES
Provider Second Line Business Mailing Address:
2500 HALL AVE SUITE A
Provider Business Mailing Address City Name:
MARINETTE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-732-7760
Provider Business Mailing Address Fax Number:
715-732-7711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MARINETTE COUNTY HEALTH AND HUMAN SERVICES
Provider Second Line Business Practice Location Address:
1201 JACKSON ST
Provider Business Practice Location Address City Name:
MARINETTE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-732-7760
Provider Business Practice Location Address Fax Number:
715-732-7711
Provider Enumeration Date:
10/12/2006

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 39749500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".