Provider Demographics
NPI:1407379274
Name:WAWRZYNIAKOWSKI, JUNE (LPN)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:
Last Name:WAWRZYNIAKOWSKI
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 1:817 S WEED ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-3023
Mailing Address - Country:US
Mailing Address - Phone:715-304-9850
Mailing Address - Fax:
Practice Address - Street 1:817 S. WEED ST.
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-5416
Practice Address - Country:US
Practice Address - Phone:715-304-9850
Practice Address - Fax:715-304-9850
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI312907164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse