Organization
CLEVELAND VA CBOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACEY JEAN HIBBARD (LPN)
(920) 693-5600
Entity
Organization
Contact information
Practice address
1205 NORTH AVE, CLEVELAND, WI 53015-1413
(188) 846-9661
Mailing address
631 MARK AVE, SHEBOYGAN FALLS, WI 53085-1721
(920) 467-6079
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
18107-031
WI
Other
Enumeration date
07/16/2006
Last updated
08/22/2020
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