Provider Demographics
NPI:1215305487
Name:FLOWERS, DENETTA LAURAELAINE (LPN)
Entity type:Individual
Prefix:
First Name:DENETTA
Middle Name:LAURAELAINE
Last Name:FLOWERS
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 1:4311 DURAND AVE.
Mailing Address - Street 2:#104
Mailing Address - City:MT.PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405
Mailing Address - Country:US
Mailing Address - Phone:262-989-9392
Mailing Address - Fax:
Practice Address - Street 1:4311 DURAND AVE.
Practice Address - Street 2:#104
Practice Address - City:MT.PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405
Practice Address - Country:US
Practice Address - Phone:262-989-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI318068-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse