MEDICARE: JOLIE CETNAROWSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	13798	WI

General Provider Information

NPI Number	:	1578250429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOLIE CETNAROWSKI

Provider Business Mailing Address
First Line	:	200 OCEANGATE STE 100
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4317
Country	:	US
Telephone Number	:	888-562-5442
Fax Number	:

Provider Business Practice Location Address
First Line	:	11002 W PARK PL
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-3615
Country	:	US
Telephone Number	:	888-999-2404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2023
Last Update Date	:	04/20/2023

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Directions to “ JOLIE CETNAROWSKI ” Practice Location

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