is a Licensed Practical Nurse in Two Rivers, Wisconsin. practices all healthcare services and medical treatments related to Licensed Practical Nurse. The NPI Number for is 1396902045. The last update date is .
's current location address is 1601 Shoto Rd, Two Rivers, Wisconsin. You can contact this provider via phone number 9206843871. The mailing address for is 1601 Shoto Rd, Two Rivers, Wisconsin. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 1601 Shoto Rd, Two Rivers, Wisconsin |
| Phone Number | 9206843871 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1396902045 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 1601 Shoto Rd |
|---|---|
| City | Two Rivers |
| State | Wisconsin (WI) |
| Post Code | 542419184 |
| Phone Number | 9206843871 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Licensed Practical Nurse |
|---|---|
| Taxonomy | 164W00000X |
| Licence No | 14540-031 |
|
Definition: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job r |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 38239900 | WI | -- |
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