Provider Demographics
NPI:1205295649
Name:LANOWAY, CHAD (RN)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:LANOWAY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 STATE ROAD 138
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON, WI
Mailing Address - State:WI
Mailing Address - Zip Code:53589
Mailing Address - Country:US
Mailing Address - Phone:608-719-8876
Mailing Address - Fax:
Practice Address - Street 1:1104 STATE ROAD 138
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-4049
Practice Address - Country:US
Practice Address - Phone:608-719-8876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-13
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI221313163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse