Provider Demographics
NPI:1821332867
Name:SUPRISE, JANE HELENE (CPNT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:HELENE
Last Name:SUPRISE
Suffix:
Gender:F
Credentials:CPNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W WINNEBAGO ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4533
Mailing Address - Country:US
Mailing Address - Phone:920-574-2561
Mailing Address - Fax:
Practice Address - Street 1:1191 WESTOWNE DR
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2176
Practice Address - Country:US
Practice Address - Phone:920-725-3152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other