Healthcare Provider Details

I. General information

NPI: 1881139087
Provider Name (Legal Business Name): THERESA MARIE BEHNKE RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 12/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD
GREEN BAY WI
54311-6519
US

IV. Provider business mailing address

2845 GREENBRIER RD
GREEN BAY WI
54311-6519
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-4602
  • Fax: 920-288-4622
Mailing address:
  • Phone: 920-288-4602
  • Fax: 920-288-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number105230
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: