Provider Demographics
NPI:1881275501
Name:LEDVINA, JOEL SPENCER
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:SPENCER
Last Name:LEDVINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-1632
Mailing Address - Country:US
Mailing Address - Phone:920-676-8384
Mailing Address - Fax:
Practice Address - Street 1:105 E BLUFF ST
Practice Address - Street 2:
Practice Address - City:BOSCOBEL
Practice Address - State:WI
Practice Address - Zip Code:53805-1610
Practice Address - Country:US
Practice Address - Phone:608-375-4549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program