Provider Demographics
NPI:1528188646
Name:SOKO, TENNEH MOIBAH (LPN)
Entity Type:Individual
Prefix:
First Name:TENNEH
Middle Name:MOIBAH
Last Name:SOKO
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 1:3650 BRECKENRIDGE CT APT 16
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3655
Mailing Address - Country:US
Mailing Address - Phone:608-271-0514
Mailing Address - Fax:
Practice Address - Street 1:1649 VERNON ST
Practice Address - Street 2:#4
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-2277
Practice Address - Country:US
Practice Address - Phone:608-873-6835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38338800OtherPROVIDER #