Individual
MARIE HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1112 IVY ST, BLOOMER, WI 54724-1444
(715) 828-1482
Mailing address
1112 IVY ST, BLOOMER, WI 54724-1444
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
19871-31
WI
Other
Enumeration date
05/23/2017
Last updated
05/23/2017
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