Individual
CLARE DESTREE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N
Contact information
Practice address
10732 BELGIAN DR, BRUSSELS, WI 54204-9713
(920) 619-1938
Mailing address
10732 BELGIAN DR, BRUSSELS, WI 54204-9713
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
12431-031
WI
Other
Enumeration date
08/20/2010
Last updated
08/20/2010
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