Provider Demographics
NPI:1689825630
Name:SAMMARTINO, JEANNE LOUISE
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:LOUISE
Last Name:SAMMARTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 GRIFFITH AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-2706
Mailing Address - Country:US
Mailing Address - Phone:715-423-6962
Mailing Address - Fax:
Practice Address - Street 1:4231 GRIFFITH AVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-2706
Practice Address - Country:US
Practice Address - Phone:715-423-6962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35151282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural