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General NPI Number Information
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NPI Number | 1396074340
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Entity Type | Organization
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Legal Business Name | ESSENTIAL ENERGY L.L.C.
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | W2499 COUNTY ROAD T
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City | DURAND
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State | WI
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Zip | 54736-5063
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Country | US
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Telephone | 715-495-5984
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Fax |
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Provider Business Mailing Address
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Address Line | W2499 COUNTY ROAD T
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City | DURAND
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State | WI
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Zip | 54736-5063
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Country | US
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Telephone | 715-495-5984
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Fax |
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Authorized Official
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Title or Position | MASSAGE PRACTITIONER
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Name | GLENDA KOMRO
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Credential | L.P.N.
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Telephone | 715-495-5984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | NONE
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License Number State | WI
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