Individual
MISS TRISTA DELORIS CLEMMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
618 S CHURCH ST, GRANTSBURG, WI 54840-7866
(715) 220-1995
Mailing address
618 S CHURCH ST, GRANTSBURG, WI 54840-7866
(715) 220-1995
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
306540-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3950845470
—
WI
Enumeration date
05/15/2008
Last updated
05/15/2008
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