| Jacqueline Susan Moe, APNP | |
|
W3275 Wolf River Dr, Keshena, WI 54135-9202 | |
| (715) 799-3361 | |
| Not Available |
| Full Name | Jacqueline Susan Moe |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner |
| Experience | 19 Years |
| Location | W3275 Wolf River Dr, Keshena, Wisconsin |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902995251 | NPI | - | NPPES |
| 36015400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363L00000X | Nurse Practitioner | 2966-033 (Wisconsin) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 2966-033 (Wisconsin) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Thedacare Regional Med Ctr - Neenah | Neenah, WI | Hospital |
| Thedacare Medical Center - Shawano | Shawano, WI | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Menominee Indian Tribe Of Wisconsin | 2668459264 | 23 |
| Entity Name | Thedacare Incorporated |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1376656959 PECOS PAC ID: 1759294887 Enrollment ID: O20031106000088 |
| Entity Name | Menominee Indian Tribe Of Wisconsin |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1568404721 PECOS PAC ID: 2668459264 Enrollment ID: O20040701000838 |
| Mailing Address | Practice Location Address |
|---|---|
| Jacqueline Susan Moe, APNP Po Box 970, Keshena, WI 54135-0970 Ph: (715) 799-3361 | Jacqueline Susan Moe, APNP W3275 Wolf River Dr, Keshena, WI 54135-9202 Ph: (715) 799-3361 |
Sue C Weso, APNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: W3275 Wolf River Road, Keshena, WI 54135 Phone: 715-799-3361 Fax: 715-799-3099 | |
Sarah Harkey, APNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: W3275 Wolf River Road, Keshena, WI 54135 Phone: 715-799-3361 | |
Stephanie Diane Hurda, APNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: W3275 Wolf River Dr, Keshena, WI 54135 Phone: 715-304-9830 | |
Elizabeth A Radtke-petri, N.P. Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: W3275 Wolf River Road, Keshena, WI 54135 Phone: 715-799-3361 Fax: 715-799-3099 |