=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598373060
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMI MARKOS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2020
-----------------------------------------------------
Last Update Date | 04/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 AMERICAN AVE
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53188-5031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-928-4695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 727 SURREY LN
-----------------------------------------------------
City | HARTLAND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53029-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-510-9108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 10323
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 221276
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------