Individual
DAVID NEAL INNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN, LICSW
Contact information
Practice address
320 PARK AVE, JANESVILLE, WI 53548-4620
(608) 359-3357
Mailing address
320 PARK AVE, JNAESVILLE, WI 53548
(608) 359-3357
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
307611-31
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
307611-31
LPN
WI
Enumeration date
10/08/2010
Last updated
10/08/2010
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