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Individual

MS. BETTY S THUNDER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ADVANCED PRACTICE SO

Contact information

Practice address
5409 EVERYBODY'S ROAD, FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER, CRANDON, WI 54520
(715) 478-4300
(715) 478-4490
Mailing address
PO BOX 396, 5409 EVERYBODY'S ROAD FOREST COUNTY POTAWATOMI HEALTH, CRANDON, WI 54520
(715) 478-4300
(715) 478-4490

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
677121
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
39700200
WI
01
66628
SECURITY HEALTH PLAN
WI
Enumeration date
08/04/2006
Last updated
07/08/2007
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