Individual
CERENA EDICT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1721 LENWOOD AVE APT 8, GREEN BAY, WI 54303-6398
(920) 634-1293
Mailing address
1721 LENWOOD AVE APT 8, GREEN BAY, WI 54303-6398
(920) 634-1293
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
110616930
WI
Other
Enumeration date
04/07/2026
Last updated
04/07/2026
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