Individual
THERESA ERTL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1014 LONG CT, SPARTA, WI 54656-2552
(920) 410-8539
Mailing address
1014 LONG CT, SPARTA, WI 54656-2552
(920) 410-8539
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
173659-30
WI
Other
Enumeration date
07/17/2014
Last updated
07/17/2014
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