Provider Demographics
NPI:1104802602
Name:HOKENSON, CHERYL LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNN
Last Name:HOKENSON
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 1:7440 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2230
Mailing Address - Country:US
Mailing Address - Phone:414-476-4687
Mailing Address - Fax:
Practice Address - Street 1:141 S LAKESHORE DR
Practice Address - Street 2:A6
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-9661
Practice Address - Country:US
Practice Address - Phone:262-552-0229
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71128030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39974300Medicaid