Healthcare Provider Details

I. General information

NPI: 1881930816
Provider Name (Legal Business Name): THEODORE ALLEN KUHNS CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15470 PINEWOOD DR LOT 91
HAYWARD WI
54843-2664
US

IV. Provider business mailing address

15470 PINEWOOD DR LOT 91
HAYWARD WI
54843-2664
US

V. Phone/Fax

Practice location:
  • Phone: 715-558-0340
  • Fax:
Mailing address:
  • Phone: 715-558-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number315027
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: