Provider Demographics
NPI:1962654202
Name:SODERBERG, VICKI LEE (LPN)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LEE
Last Name:SODERBERG
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:W7955 CREEK RD TRLR 402
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-3181
Mailing Address - Country:US
Mailing Address - Phone:262-740-1755
Mailing Address - Fax:
Practice Address - Street 1:W7955 CREEK RD TRLR 402
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-3181
Practice Address - Country:US
Practice Address - Phone:262-740-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI306484-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse