Provider Demographics
NPI:1508055096
Name:JESCHKE, JO ANN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:JO
Middle Name:ANN
Last Name:JESCHKE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858-2650
Mailing Address - Country:US
Mailing Address - Phone:906-864-4474
Mailing Address - Fax:
Practice Address - Street 1:1500 16TH AVE
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-2650
Practice Address - Country:US
Practice Address - Phone:906-864-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38327700OtherMEDICAID PROVIDER