Individual
NICOLE RENAE MAIWALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1610 MILLER PARK WAY, WEST MILWAUKEE, WI 53214-3604
(414) 939-7556
Mailing address
1828 RAPIDS DR, RACINE, WI 53404-2133
(262) 234-2643
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
327354-31
WI
Other
Enumeration date
11/29/2023
Last updated
11/29/2023
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