Provider Demographics
NPI:1497928329
Name:JERUE, BARBARA LYNN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:LYNN
Last Name:JERUE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 7TH ST N
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3368
Mailing Address - Country:US
Mailing Address - Phone:608-785-9843
Mailing Address - Fax:608-785-9299
Practice Address - Street 1:400 7TH ST N
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3368
Practice Address - Country:US
Practice Address - Phone:608-785-9843
Practice Address - Fax:608-785-9299
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3365016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist