Provider Demographics
NPI:1053423392
Name:CHARNETSKI, JANE MARIE (FNP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:CHARNETSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:MARIE
Other - Last Name:ENGELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 13508
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-3508
Mailing Address - Country:US
Mailing Address - Phone:920-433-0111
Mailing Address - Fax:920-884-5306
Practice Address - Street 1:835 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3526
Practice Address - Country:US
Practice Address - Phone:920-433-0111
Practice Address - Fax:920-884-5306
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI88987-030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43868700Medicaid
S48079Medicare UPIN
WI43868700Medicaid