Basic Information
| Provider Information | |||||||||
| NPI: | 1881797462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCINTOSH | ||||||||
| FirstName: | JOSEPHINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | N8931 COUNTY ROAD DK | ||||||||
| Address2: | |||||||||
| City: | DYCKESVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542179685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7016106169 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2430 E MASON ST | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543023759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204457377 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 06/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R19389 | ND | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | R090749-1 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | A-122356 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 4055 | WI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | P1200504 | 01 | MN | RR MEDICARE | OTHER | 15689 | 01 | IA | WELLMARK BLUE CROSS BLUE SHIELD | OTHER | 19534 | 05 | ND | MEDICAID | 0076372 | 05 | IA | MEDICAID |