Provider Demographics
NPI:1336270792
Name:FEUERER, JACQUELINE L (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:FEUERER
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:W310S7781 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9225
Mailing Address - Country:US
Mailing Address - Phone:262-363-8079
Mailing Address - Fax:
Practice Address - Street 1:W310S7781 ARBOR DR
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9225
Practice Address - Country:US
Practice Address - Phone:262-363-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63542-030163WH0200X, 163WN0002X, 163WN0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Not Answered163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38275600Medicaid