Provider Demographics
NPI:1205445509
Name:TENPAS, KELSEY (LPN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:TENPAS
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 1:8232 STATE HIGHWAY 73
Mailing Address - Street 2:
Mailing Address - City:PITTSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54466-9336
Mailing Address - Country:US
Mailing Address - Phone:715-213-6115
Mailing Address - Fax:
Practice Address - Street 1:8232 STATE HIGHWAY 73
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54466-9336
Practice Address - Country:US
Practice Address - Phone:715-213-6115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI323688164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse