Provider Demographics
NPI:1407814221
Name:FLADHAMMER, JUDY RAE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:RAE
Last Name:FLADHAMMER
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 1:14 E COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563
Mailing Address - Country:US
Mailing Address - Phone:608-868-7466
Mailing Address - Fax:608-868-5474
Practice Address - Street 1:14 E COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WI
Practice Address - Zip Code:53563
Practice Address - Country:US
Practice Address - Phone:608-868-7466
Practice Address - Fax:608-868-5474
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12438031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39980500Medicaid