Healthcare Provider Details

I. General information

NPI: 1467683474
Provider Name (Legal Business Name): WENDY E ZOSKE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N53W35785 HILLVIEW CT
OCONOMOWOC WI
53066-3237
US

IV. Provider business mailing address

N53W35785 HILLVIEW CT
OCONOMOWOC WI
53066-3237
US

V. Phone/Fax

Practice location:
  • Phone: 262-567-7642
  • Fax:
Mailing address:
  • Phone: 262-567-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number148516-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: