Provider Demographics
NPI:1881797462
Name:MCINTOSH, JOSEPHINE M (APRN, CNP)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:M
Last Name:MCINTOSH
Suffix:
Gender:
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8931 COUNTY ROAD DK
Mailing Address - Street 2:
Mailing Address - City:DYCKESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54217-9685
Mailing Address - Country:US
Mailing Address - Phone:701-610-6169
Mailing Address - Fax:
Practice Address - Street 1:2430 E MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-3759
Practice Address - Country:US
Practice Address - Phone:920-445-7377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR19389363L00000X
WI4055363LF0000X
MN2536363LF0000X
IAA-122356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0076372Medicaid
ND19534Medicaid
MNP1200504OtherRR MEDICARE
IA15689OtherWELLMARK BLUE CROSS BLUE SHIELD
IA0076372Medicaid
MNP1200504OtherRR MEDICARE
ND13466Medicare ID - Type Unspecified