Provider Demographics
NPI:1679521462
Name:VEENHUIS, CAROL S (LPN)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:S
Last Name:VEENHUIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 SAN JUAN TRL
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-7625
Mailing Address - Country:US
Mailing Address - Phone:262-783-4414
Mailing Address - Fax:262-783-4414
Practice Address - Street 1:3245 SAN JUAN TRL
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-7625
Practice Address - Country:US
Practice Address - Phone:262-783-4414
Practice Address - Fax:262-783-4414
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5742031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse