Provider Demographics
NPI:1790754141
Name:VIKE, TONYA JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:JO
Last Name:VIKE
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 1:1851 HAMMOND RD
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-9554
Mailing Address - Country:US
Mailing Address - Phone:608-873-5272
Mailing Address - Fax:
Practice Address - Street 1:1851 HAMMOND RD
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-9554
Practice Address - Country:US
Practice Address - Phone:608-873-5272
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3899885010Medicaid
WI3875098600Medicaid