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General NPI Number Information
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NPI Number | 1730474347
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Entity Type | Individual
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Provider Name | SALLY JO LEDVINA APNP
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Gender | Female
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | E1430 KRINES RD
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City | LUXEMBURG
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State | WI
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Zip | 54217-7731
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Country | US
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Telephone | 920-863-6580
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19070
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City | GREEN BAY
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State | WI
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Zip | 54307-9070
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Country | US
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Telephone | 920-496-4700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4387-033
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License Number State | WI
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