Provider Demographics
NPI:1972801165
Name:DALUZ, JENNIFER ROSE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:DALUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 N GAMMON RD
Mailing Address - Street 2:F
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3810
Mailing Address - Country:US
Mailing Address - Phone:608-446-4071
Mailing Address - Fax:
Practice Address - Street 1:1312 N GAMMON RD
Practice Address - Street 2:F
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3810
Practice Address - Country:US
Practice Address - Phone:608-446-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI313561-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse