Provider Demographics
NPI:1871758300
Name:KROCKER, MARIAN R (LPN)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:R
Last Name:KROCKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 14TH ST
Mailing Address - Street 2:PO BOX 526
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1535
Mailing Address - Country:US
Mailing Address - Phone:608-356-9318
Mailing Address - Fax:608-356-9321
Practice Address - Street 1:626 14TH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1535
Practice Address - Country:US
Practice Address - Phone:608-356-9318
Practice Address - Fax:608-356-9321
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27555-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse