Individual
JACQUELINE SUSAN MOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
W3275 WOLF RIVER DR, KESHENA, WI 54135-9202
(715) 799-3361
Mailing address
PO BOX 970, KESHENA, WI 54135-0970
(715) 799-3361
(715) 799-5854
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2966-033
WI
363LF0000X
Family Nurse Practitioner
Primary
2966-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36015400
—
WI
Enumeration date
10/12/2006
Last updated
07/29/2020
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