Provider Demographics
NPI:1225279235
Name:WOLDANSKI, BEVERLY MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:MARIE
Last Name:WOLDANSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W9042 W TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-4173
Mailing Address - Country:US
Mailing Address - Phone:608-883-2373
Mailing Address - Fax:
Practice Address - Street 1:W9042 W TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-4173
Practice Address - Country:US
Practice Address - Phone:608-883-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310852-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI$$$$$$$$$Medicaid