Provider Demographics
NPI:1598236069
Name:SROKA, JEANNETTE (RN)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:SROKA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W1877 CALMAR RD
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:WI
Mailing Address - Zip Code:53049-1321
Mailing Address - Country:US
Mailing Address - Phone:920-904-5416
Mailing Address - Fax:
Practice Address - Street 1:23 W SCOTT ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-2342
Practice Address - Country:US
Practice Address - Phone:920-926-0101
Practice Address - Fax:920-926-0060
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI159435163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)