Individual
KOURTNEY CHRISTIN HENRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1946 30TH ST, TWO RIVERS, WI 54241-2022
(920) 905-3307
Mailing address
1946 30TH ST, TWO RIVERS, WI 54241-2022
(920) 905-3307
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
314450-031
WI
Other
Enumeration date
04/09/2012
Last updated
04/09/2012
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