MEDICARE: CORI LYN DYNEK RN,BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	147857-30	WI

General Provider Information

NPI Number	:	1124266259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORI LYN DYNEK RN,BSN

Provider Business Mailing Address
First Line	:	539 CLEVELAND AVE
Second Line	:
City	:	HARTFORD
State	:	WI
Zip	:	53027-2729
Country	:	US
Telephone Number	:	414-699-9845
Fax Number	:

Provider Business Practice Location Address
First Line	:	539 CLEVELAND AVE
Second Line	:
City	:	HARTFORD
State	:	WI
Zip	:	53027-2729
Country	:	US
Telephone Number	:	414-699-9845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2009
Last Update Date	:	01/27/2009

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