Provider Demographics
NPI:1790546935
Name:KAKUSKE, JENNIFER (RN BSN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KAKUSKE
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5502 SEDGEMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-1249
Mailing Address - Country:US
Mailing Address - Phone:608-333-5516
Mailing Address - Fax:
Practice Address - Street 1:6741 RESTON HEIGHTS DR UNIT 1
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-3377
Practice Address - Country:US
Practice Address - Phone:608-333-5516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148446-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health