Healthcare Provider Details

I. General information

NPI: 1861716359
Provider Name (Legal Business Name): KERI LYNN SCARPACE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 HILLVIEW CT
HUBERTUS WI
53033-9603
US

IV. Provider business mailing address

3715 HILLVIEW CT
HUBERTUS WI
53033-9603
US

V. Phone/Fax

Practice location:
  • Phone: 262-623-0290
  • Fax:
Mailing address:
  • Phone: 262-623-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number34241-31
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: