Individual
GE LO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
625 W WASHINGTON AVE, MADISON, WI 53703-2637
(608) 280-2700
Mailing address
625 W WASHINGTON AVE, MADISON, WI 53703-2637
(608) 280-2700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
178181-030
WI
Other
Enumeration date
08/25/2015
Last updated
08/25/2015
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