Provider Demographics
NPI:1063430411
Name:JOLIVETTE, SHARON (RN, CNM)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:JOLIVETTE
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2340
Mailing Address - Country:US
Mailing Address - Phone:608-775-8380
Mailing Address - Fax:608-775-8385
Practice Address - Street 1:1201 CALEDONIA ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-2514
Practice Address - Country:US
Practice Address - Phone:608-775-8380
Practice Address - Fax:608-775-8385
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39905900Medicaid