Provider Demographics
NPI:1821118001
Name:SKOWRONSKI, LORALAINE ANN (RN)
Entity Type:Individual
Prefix:
First Name:LORALAINE
Middle Name:ANN
Last Name:SKOWRONSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LORALAINE
Other - Middle Name:ANN
Other - Last Name:MOGENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 S 64TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3241
Mailing Address - Country:US
Mailing Address - Phone:414-732-2458
Mailing Address - Fax:
Practice Address - Street 1:12250 W NORTH AVE
Practice Address - Street 2:APT. 222
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2063
Practice Address - Country:US
Practice Address - Phone:414-476-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101201-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39849600Medicaid