Provider Demographics
NPI:1811122492
Name:HANEWOLD, LENORE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:LENORE
Middle Name:MARIE
Last Name:HANEWOLD
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 1:1522 BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-1924
Mailing Address - Country:US
Mailing Address - Phone:608-774-0487
Mailing Address - Fax:
Practice Address - Street 1:1522 BENNETT ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-1924
Practice Address - Country:US
Practice Address - Phone:608-774-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309510164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse