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General NPI Number Information
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NPI Number | 1528188646
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Entity Type | Individual
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Provider Name | TENNEH MOIBAH SOKO LPN
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1649 VERNON ST #4
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City | STOUGHTON
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State | WI
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Zip | 53589-2277
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Country | US
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Telephone | 608-873-6835
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Fax |
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Provider Business Mailing Address
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Address Line | 3650 BRECKENRIDGE CT APT 16
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City | FITCHBURG
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State | WI
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Zip | 53713-3655
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Country | US
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Telephone | 608-271-0514
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State | WI
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