Provider Demographics
NPI:1093861528
Name:TESKE, JANET J (APNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:J
Last Name:TESKE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53076-9640
Mailing Address - Country:US
Mailing Address - Phone:262-628-0619
Mailing Address - Fax:
Practice Address - Street 1:12601 W HAMPTON AVE
Practice Address - Street 2:#100A
Practice Address - City:BUTLER
Practice Address - State:WI
Practice Address - Zip Code:53007-1705
Practice Address - Country:US
Practice Address - Phone:262-373-1869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2611-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP28507Medicare UPIN