Provider Demographics
NPI:1639872195
Name:LARDINOIS, BRITTENY N (BSN)
Entity type:Individual
Prefix:
First Name:BRITTENY
Middle Name:N
Last Name:LARDINOIS
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 SYCAMORE DR APT 22
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5141
Mailing Address - Country:US
Mailing Address - Phone:920-819-9144
Mailing Address - Fax:
Practice Address - Street 1:2410 SYCAMORE DR APT 22
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5141
Practice Address - Country:US
Practice Address - Phone:920-819-9144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI108665530163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse