Individual
BETHANY CERVENANSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6769 WINKLER RD, THREE LAKES, WI 54562-9369
(715) 546-3983
Mailing address
PO BOX 105, THREE LAKES, WI 54562-0105
(715) 546-3983
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
310395-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35068000
—
WI
Enumeration date
09/11/2008
Last updated
09/11/2008
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