Provider Demographics
NPI:1982810602
Name:PRIEST, VIRGINIA ROSE (LM)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ROSE
Last Name:PRIEST
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3631 SLATTS RD
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:WI
Mailing Address - Zip Code:53011-1105
Mailing Address - Country:US
Mailing Address - Phone:920-528-7072
Mailing Address - Fax:
Practice Address - Street 1:N3631 SLATTS RD
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:WI
Practice Address - Zip Code:53011-1105
Practice Address - Country:US
Practice Address - Phone:920-528-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16-049176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife