Provider Demographics
NPI:1265796890
Name:BOISSY, JEANETTE (RN)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:BOISSY
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 1:935 235TH ST
Mailing Address - Street 2:
Mailing Address - City:DRESSER
Mailing Address - State:WI
Mailing Address - Zip Code:54009-9073
Mailing Address - Country:US
Mailing Address - Phone:715-755-3503
Mailing Address - Fax:
Practice Address - Street 1:805 200TH ST
Practice Address - Street 2:
Practice Address - City:DRESSER
Practice Address - State:WI
Practice Address - Zip Code:54009-4509
Practice Address - Country:US
Practice Address - Phone:715-755-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI177109-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse