Provider Demographics
NPI:1447701644
Name:CAFOUREK, JEANNE MARCILE (RN)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:MARCILE
Last Name:CAFOUREK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JEANNE
Other - Middle Name:MARCILE
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2423 22ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-5816
Mailing Address - Country:US
Mailing Address - Phone:507-280-7895
Mailing Address - Fax:
Practice Address - Street 1:2423 22ND AVE SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-5816
Practice Address - Country:US
Practice Address - Phone:507-280-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-23
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 92996-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN009309Medicaid