Individual
TIMOTHY DETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
2500 OVERLOOK TER, MADISON, WI 53705-2254
(608) 280-7110
Mailing address
2500 OVERLOOK TER, MADISON, WI 53705-2254
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
31514-31
WI
Other
Enumeration date
06/07/2008
Last updated
06/07/2008
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