1609985589 NPI number — JOSIE DICESARE CFNP

Table of content: JOSIE DICESARE CFNP (NPI 1609985589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609985589 NPI number — JOSIE DICESARE CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICESARE
Provider First Name:
JOSIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEBB
Provider Other First Name:
JOSIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CFNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609985589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 TOWER AVE
Provider Second Line Business Mailing Address:
SUITE ONE
Provider Business Mailing Address City Name:
SUPERIOR
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54880-5337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-392-1955
Provider Business Mailing Address Fax Number:
715-392-1935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 TOWER AVE
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
SUPERIOR
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54880-5337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-392-1955
Provider Business Practice Location Address Fax Number:
715-392-1935
Provider Enumeration Date:
08/30/2006

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: 363LF0000X , with the licence number:  1729 , 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: 1729 . This is a "LICENSE CFNP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 73184 . This is a "LICENSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 205368-22 . This is a "LICENSE CFNP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: NA9591046225 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01-13331 . This is a "MEDICA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 128160-8 . This is a "LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 475646313005 . This is a "BCBS-WI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 87G58WE . This is a "BCBS-MN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 015R2WE . This is a "BCBS-MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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