Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 83716 | WI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 83716 | WI |
N | 363LW0102X | Nurse Practitioner - Women's Health | 666033 | WI |
NPI | 1063493666 |
---|---|
Provider Name | Delrose D Jones |
First Address | La Crosse, WI 54601-8806 |
Second Address | Onalaska, WI 54650-8679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 28/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S78672 | (02) |