Provider Demographics
NPI:1982443321
Name:KRACAW, JENNIFER A
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:KRACAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-6123
Mailing Address - Country:US
Mailing Address - Phone:920-242-1382
Mailing Address - Fax:
Practice Address - Street 1:1601 S 16TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6123
Practice Address - Country:US
Practice Address - Phone:920-242-1382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore Provider
No385H00000XRespite Care FacilityRespite Care