Provider Demographics
NPI:1720410038
Name:DESCHANE, VIRGINIA L (RN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:DESCHANE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 LULU AVE
Mailing Address - Street 2:
Mailing Address - City:CRIVITZ
Mailing Address - State:WI
Mailing Address - Zip Code:54114-1584
Mailing Address - Country:US
Mailing Address - Phone:920-246-0831
Mailing Address - Fax:
Practice Address - Street 1:602 LULU AVE
Practice Address - Street 2:
Practice Address - City:CRIVITZ
Practice Address - State:WI
Practice Address - Zip Code:54114-1584
Practice Address - Country:US
Practice Address - Phone:920-246-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI97235-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health