Provider Demographics
NPI:1912484494
Name:SVENDSEN, DUSTIN ANDREW
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:ANDREW
Last Name:SVENDSEN
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 1:1014 VINE ST
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53182-1330
Mailing Address - Country:US
Mailing Address - Phone:262-939-3443
Mailing Address - Fax:
Practice Address - Street 1:1344 JEAN ST
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-1402
Practice Address - Country:US
Practice Address - Phone:262-939-3443
Practice Address - Fax:262-878-5074
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0016153376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker