Individual
MS. MEGAN ELIZABETH DEVICTORIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
4816 21ST AVE, KENOSHA, WI 53140-5911
(262) 577-4634
Mailing address
4816 21ST AVE, KENOSHA, WI 53140-5911
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
321070
WI
Other
Enumeration date
01/01/2018
Last updated
01/01/2018
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