Healthcare Provider Details

I. General information

NPI: 1053695189
Provider Name (Legal Business Name): TONYA LA FLEUR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E CAMPUS MALL
MADISON WI
53715-1365
US

IV. Provider business mailing address

333 E CAMPUS MALL
MADISON WI
53715-1365
US

V. Phone/Fax

Practice location:
  • Phone: 608-262-4730
  • Fax: 608-262-9160
Mailing address:
  • Phone: 608-262-4730
  • Fax: 608-262-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number129108-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: