Provider Demographics
NPI:1003174871
Name:COX, DOREEN ELISE (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:ELISE
Last Name:COX
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:MISS
Other - First Name:DOREEN
Other - Middle Name:ELISE
Other - Last Name:JUSTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:20522 10TH CT
Mailing Address - Street 2:
Mailing Address - City:GALESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54630-7158
Mailing Address - Country:US
Mailing Address - Phone:920-926-0729
Mailing Address - Fax:
Practice Address - Street 1:1407 SAINT ANDREW ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-3301
Practice Address - Country:US
Practice Address - Phone:608-785-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI102413-30163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health