Healthcare Provider Details

I. General information

NPI: 1811167265
Provider Name (Legal Business Name): MR. TODD MICHAEL VARNES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2008
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 LUKE LN
DANE WI
53529-9515
US

IV. Provider business mailing address

411 LUKE LN
DANE WI
53529-9515
US

V. Phone/Fax

Practice location:
  • Phone: 608-843-8623
  • Fax:
Mailing address:
  • Phone: 608-843-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number185801-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: