Provider Demographics
NPI:1376753145
Name:SPAAY-JOSLIN, LORELI E (RN)
Entity Type:Individual
Prefix:MS
First Name:LORELI
Middle Name:E
Last Name:SPAAY-JOSLIN
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 1:1809 N DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-2509
Mailing Address - Country:US
Mailing Address - Phone:920-831-0611
Mailing Address - Fax:
Practice Address - Street 1:1809 N DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-2509
Practice Address - Country:US
Practice Address - Phone:920-831-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39958000Medicaid