Provider Demographics
NPI:1861660680
Name:MUENCH, MARSHA SUE (LPN)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:SUE
Last Name:MUENCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:SUE
Other - Last Name:HEINRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1304 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-5134
Mailing Address - Country:US
Mailing Address - Phone:920-457-1804
Mailing Address - Fax:
Practice Address - Street 1:1304 S 19TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-5134
Practice Address - Country:US
Practice Address - Phone:920-457-1804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35050100Medicaid