Provider Demographics
NPI:1841798170
Name:DAHL, LONIE LOUISE (LPN)
Entity Type:Individual
Prefix:MS
First Name:LONIE
Middle Name:LOUISE
Last Name:DAHL
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 1:472 BRAGG ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3979
Mailing Address - Country:US
Mailing Address - Phone:920-382-3785
Mailing Address - Fax:
Practice Address - Street 1:472 BRAGG ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3979
Practice Address - Country:US
Practice Address - Phone:920-382-3785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI305629-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse