Provider Demographics
NPI:1376829960
Name:THORMODSON, KRISTINE MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:MARIE
Last Name:THORMODSON
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 1:2000 N OXFORD AVE
Mailing Address - Street 2:BUILDING TWO
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5184
Mailing Address - Country:US
Mailing Address - Phone:715-834-1074
Mailing Address - Fax:715-834-1078
Practice Address - Street 1:2000 N OXFORD AVE
Practice Address - Street 2:BUILDING TWO
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5184
Practice Address - Country:US
Practice Address - Phone:715-834-1074
Practice Address - Fax:715-834-1078
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310367-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse