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General NPI Number Information
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NPI Number | 1275205387
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Entity Type | Individual
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Provider Name | JOEL ROBERT IBELING AEMT
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Gender | Male
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 3250 KINGSLEY WAY
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City | MADISON
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State | WI
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Zip | 53713-4628
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Country | US
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Telephone | 608-354-9239
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Fax |
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Provider Business Mailing Address
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Address Line | 315 ORIOLE LN
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City | CAMBRIDGE
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State | WI
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Zip | 53523-9297
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Country | US
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Telephone | 608-512-5473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146M00000X
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Taxonomy Name | Intermediate Emergency Medical Technician
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License Number | 300168
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License Number State | WI
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