Organization
NONE
Active
Other names
none
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN KSOBIECH (REGISTERED NURSE)
(414) 241-7583
Entity
Organization
Contact information
Practice address
6058 ORIOLE LN, GREENDALE, WI 53129-2552
(414) 241-7583
Mailing address
6058 ORIOLE LN, GREENDALE, WI 53129-2552
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
194720-30
WI
Other
Enumeration date
02/21/2013
Last updated
02/21/2013
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