Provider Demographics
NPI:1326214461
Name:WALLENHORST, SUSAN KAY (RK BSN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:WALLENHORST
Suffix:
Gender:F
Credentials:RK BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 NORTH HOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:CUBA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53807-9711
Mailing Address - Country:US
Mailing Address - Phone:608-744-8713
Mailing Address - Fax:
Practice Address - Street 1:1510 DEBORAH COURT
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818
Practice Address - Country:US
Practice Address - Phone:608-348-5349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI69158030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse