MEDICARE: MARIAN R KROCKER LPN

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	164W00000X	Licensed Practical Nurse	27555-031	WI

General Provider Information

NPI Number	:	1871758300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN R KROCKER LPN

Provider Business Mailing Address
First Line	:	626 14TH ST
Second Line	:	PO BOX 526
City	:	BARABOO
State	:	WI
Zip	:	53913-1535
Country	:	US
Telephone Number	:	608-356-9318
Fax Number	:	608-356-9321

Provider Business Practice Location Address
First Line	:	626 14TH ST
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-1535
Country	:	US
Telephone Number	:	608-356-9318
Fax Number	:	608-356-9321

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

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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Directions to “ MARIAN R KROCKER LPN” Practice Location

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