Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 149532-030 | WI |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 149532 | WI |
NPI | 1043473242 |
---|---|
Provider Name | Teresa A. Jerofke |
First Address | Milwaukee, WI 53226-4837 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 23/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043473242 | (05) | WI |
149532-030 | STATE LICENSE (01) | WI |