Provider Demographics
NPI:1659426120
Name:KUES, JOLIENE K (APRN)
Entity Type:Individual
Prefix:
First Name:JOLIENE
Middle Name:K
Last Name:KUES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JOLIENE
Other - Middle Name:K
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54702-1510
Mailing Address - Country:US
Mailing Address - Phone:608-785-0940
Mailing Address - Fax:
Practice Address - Street 1:700 WEST AVE S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4783
Practice Address - Country:US
Practice Address - Phone:608-785-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 141267-1363L00000X
WI56607363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
WI36068400Medicaid
IAENROLLEDMedicaid
MN500005076Medicare PIN
MN500003672Medicare PIN
IAENROLLEDMedicaid
MNENROLLEDMedicaid