Provider Demographics
NPI:1467727545
Name:CIEBELL, PAULA JO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:JO
Last Name:CIEBELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4166 DEER CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-4279
Mailing Address - Country:US
Mailing Address - Phone:608-868-3667
Mailing Address - Fax:
Practice Address - Street 1:4166 DEER CROSSING DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-4279
Practice Address - Country:US
Practice Address - Phone:608-868-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310764-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse