Individual
MS. BRENDA LEE KLABACKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN,RCS
Contact information
Practice address
201 N WATER ST, WATERTOWN, WI 53094-7683
(608) 332-9510
Mailing address
2538 MYRTLE ST, MADISON, WI 53704-4541
(608) 332-9510
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
31564-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38315700
—
WI
Enumeration date
04/26/2006
Last updated
04/23/2008
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