Provider Demographics
NPI:1205899754
Name:PUERNER-FISCHER, LINDA JEAN (RN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:PUERNER-FISCHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3330 WILL RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-9797
Mailing Address - Country:US
Mailing Address - Phone:920-674-2369
Mailing Address - Fax:
Practice Address - Street 1:224 CONNELLY DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-2222
Practice Address - Country:US
Practice Address - Phone:920-674-6190
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0125389-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39928400Medicaid