Individual
YER LOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3815 HARVEST CT, OSHKOSH, WI 54901-8217
(920) 573-5014
Mailing address
3815 HARVEST CT, OSHKOSH, WI 54901-8217
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
316796-31
WI
Other
Enumeration date
01/12/2015
Last updated
01/12/2015
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