Provider Demographics
NPI:1225451610
Name:POPKO, IRENE
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:POPKO
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:W236N7132 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-2740
Mailing Address - Country:US
Mailing Address - Phone:262-246-4529
Mailing Address - Fax:
Practice Address - Street 1:W236N7132 MEADOW LN
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-2740
Practice Address - Country:US
Practice Address - Phone:262-246-4529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI78551163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse