Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080N0001X | Neonatal-Perinatal Doctor | 01056207A | IN |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 22782-20 | WI |
NPI | 1003867417 |
---|---|
Provider Name | Dr. Rose M Cipres-Jaucian |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 04/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000603384 | ANTHEM PROVIDER NUMBER (01) | IN |
009906261I | HUMANA (01) | |
200935420 | (05) | IN |
34540600 | (05) | WI |
F35269 | (02) |