Healthcare Provider Details

I. General information

NPI: 1821118001
Provider Name (Legal Business Name): LORALAINE ANN SKOWRONSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORALAINE ANN MOGENSEN

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 W NORTH AVE APT. 222
WAUWATOSA WI
53226-2063
US

IV. Provider business mailing address

1000 S 64TH ST
WEST ALLIS WI
53214-3241
US

V. Phone/Fax

Practice location:
  • Phone: 414-476-5303
  • Fax:
Mailing address:
  • Phone: 414-732-2458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number101201-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: