Healthcare Provider Details

I. General information

NPI: 1790334373
Provider Name (Legal Business Name): JEANINE ANN NOFFKE FAMILY NURSE PRACTIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEANINE ANN ASHBECK RN

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 STATE HIGHWAY 52
WABENO WI
54566-9055
US

IV. Provider business mailing address

5741 STATE HIGHWAY 52
WABENO WI
54566-9055
US

V. Phone/Fax

Practice location:
  • Phone: 920-883-8782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33-9512
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number33-9512
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: