Provider Demographics
NPI:1285926972
Name:STOKSTAD, JENIFER LEE (RN)
Entity type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:LEE
Last Name:STOKSTAD
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 1:3496 HWY 138
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589
Mailing Address - Country:US
Mailing Address - Phone:608-873-9908
Mailing Address - Fax:608-873-9908
Practice Address - Street 1:3496 HWY 138
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589
Practice Address - Country:US
Practice Address - Phone:608-873-9908
Practice Address - Fax:608-873-9908
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI140335030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health