Provider Demographics
NPI:1457751372
Name:MURKOWSKI, THERESE
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:MURKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 LAVINA DR APT 7
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3886
Mailing Address - Country:US
Mailing Address - Phone:715-302-8836
Mailing Address - Fax:
Practice Address - Street 1:213 LAVINA DR APT 7
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3886
Practice Address - Country:US
Practice Address - Phone:715-302-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI177067163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse