1821118001 NPI number — LORALAINE ANN SKOWRONSKI RN

Table of content: LORALAINE ANN SKOWRONSKI RN (NPI 1821118001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821118001 NPI number — LORALAINE ANN SKOWRONSKI RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKOWRONSKI
Provider First Name:
LORALAINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOGENSEN
Provider Other First Name:
LORALAINE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821118001
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 S 64TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ALLIS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53214-3241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-732-2458
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12250 W NORTH AVE
Provider Second Line Business Practice Location Address:
APT. 222
Provider Business Practice Location Address City Name:
WAUWATOSA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-2063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-476-5303
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2007

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: 163WH0200X , with the licence number:  101201-30 , 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)

  • Identifier: 39849600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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