Healthcare Provider Details

I. General information

NPI: 1922512706
Provider Name (Legal Business Name): JILL ANN ARENDT RN COHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL A ARENDT ZUCHOWSKI

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 RAWLINS DR
WAUKESHA WI
53188-4644
US

IV. Provider business mailing address

1250 PACIFIC AVE
LONG BEACH CA
90813-3026
US

V. Phone/Fax

Practice location:
  • Phone: 262-875-5370
  • Fax:
Mailing address:
  • Phone: 562-437-0831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number90478-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: