Provider Demographics
NPI:1487203576
Name:HOSE, JEAN ELLEN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ELLEN
Last Name:HOSE
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 1:23 E BRACKLIN ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2633
Mailing Address - Country:US
Mailing Address - Phone:715-641-0186
Mailing Address - Fax:
Practice Address - Street 1:565 16 1/2 ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:WI
Practice Address - Zip Code:54733-9543
Practice Address - Country:US
Practice Address - Phone:715-641-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty