Provider Demographics
NPI:1174099311
Name:JUREK, CARRIE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:JUREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-8551
Mailing Address - Country:US
Mailing Address - Phone:612-470-7999
Mailing Address - Fax:
Practice Address - Street 1:2900 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-8551
Practice Address - Country:US
Practice Address - Phone:612-470-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1965171100000X
WI957-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1865OtherMINNESOTA BOARD OF MEDICAL PRACTICE
WI957-55OtherSTATE OF WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES