Healthcare Provider Details

I. General information

NPI: 1093534190
Provider Name (Legal Business Name): JUSTYNA SLONIEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W5147 LYNCH LN
NECEDAH WI
54646-7954
US

IV. Provider business mailing address

W5147 LYNCH LN
NECEDAH WI
54646-7954
US

V. Phone/Fax

Practice location:
  • Phone: 608-548-7546
  • Fax:
Mailing address:
  • Phone: 608-548-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: