Healthcare Provider Details

I. General information

NPI: 1386731982
Provider Name (Legal Business Name): JENNIFER OKON R.D., C.D.E., C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. JOSEPH'S HOSPITAL DIABETES CENTER 611 SAINT JOSEPH AVE.
MARSHFIELD WI
54449
US

IV. Provider business mailing address

1508 W 8TH ST
MARSHFIELD WI
54449-3432
US

V. Phone/Fax

Practice location:
  • Phone: 715-387-7255
  • Fax: 715-378-7251
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1696-029
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: