Individual
MS. LANE ELLEN POULIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
44045 WHEATVILLE ROAD, GAYS MILLS, WI 54631
(608) 872-2156
Mailing address
44045 WHEATVILLE ROAD, GAYS MILLS, WI 54631
(608) 872-2156
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
32436031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35053100
—
WI
Enumeration date
04/02/2008
Last updated
04/02/2008
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