Provider Demographics
NPI:1699757195
Name:TRENSHAW, LORETTA MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:MARIE
Last Name:TRENSHAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7461 FERDON RD
Mailing Address - Street 2:
Mailing Address - City:NEW LISBON
Mailing Address - State:WI
Mailing Address - Zip Code:53950-9709
Mailing Address - Country:US
Mailing Address - Phone:608-562-5993
Mailing Address - Fax:608-562-5993
Practice Address - Street 1:W7461 FERDON RD
Practice Address - Street 2:
Practice Address - City:NEW LISBON
Practice Address - State:WI
Practice Address - Zip Code:53950-9709
Practice Address - Country:US
Practice Address - Phone:608-562-5993
Practice Address - Fax:608-562-5993
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40004300Medicaid