Provider Demographics
NPI:1114190527
Name:HENSLIN, CONNIE M (CST)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:M
Last Name:HENSLIN
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1358
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54936-1358
Mailing Address - Country:US
Mailing Address - Phone:920-923-0641
Mailing Address - Fax:920-923-3281
Practice Address - Street 1:210 WISCONSIN AMERICAN DR
Practice Address - Street 2:STE 235
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-2999
Practice Address - Country:US
Practice Address - Phone:920-923-0641
Practice Address - Fax:920-923-3281
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist