Provider Demographics
NPI:1881181931
Name:MIKSHOWSKY, JADE ALTMAN (DNP, APRN)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ALTMAN
Last Name:MIKSHOWSKY
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 LARK LN
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-1243
Mailing Address - Country:US
Mailing Address - Phone:507-251-7145
Mailing Address - Fax:
Practice Address - Street 1:1580 HERITAGE BLVD
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-9418
Practice Address - Country:US
Practice Address - Phone:608-518-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5911363L00000X
WI12222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner