Provider Demographics
NPI:1003978321
Name:MATUSHAK, JEAN E (RN)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:E
Last Name:MATUSHAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4152 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:WI
Mailing Address - Zip Code:54448
Mailing Address - Country:US
Mailing Address - Phone:715-352-3285
Mailing Address - Fax:715-352-3285
Practice Address - Street 1:4152 COUNTY RD N
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:WI
Practice Address - Zip Code:54448
Practice Address - Country:US
Practice Address - Phone:715-352-3285
Practice Address - Fax:715-352-3285
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38326000Medicaid