Provider Demographics
NPI:1821698341
Name:POSTUCHOW, JAQUALYNNE (CARE SPECIALIST)
Entity Type:Individual
Prefix:MS
First Name:JAQUALYNNE
Middle Name:
Last Name:POSTUCHOW
Suffix:
Gender:F
Credentials:CARE SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8739 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:SAYNER
Mailing Address - State:WI
Mailing Address - Zip Code:54560-9696
Mailing Address - Country:US
Mailing Address - Phone:414-378-8836
Mailing Address - Fax:
Practice Address - Street 1:8739 SMITH ST
Practice Address - Street 2:
Practice Address - City:SAYNER
Practice Address - State:WI
Practice Address - Zip Code:54560-9696
Practice Address - Country:US
Practice Address - Phone:414-378-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
842304531OtherESSENTIALLY NATURAL CARE