Provider Demographics
NPI:1770066680
Name:DOWD, CIERRA RENNE (LPN)
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:RENNE
Last Name:DOWD
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 1:33455 INDUSTRIAL DR LOT 38
Mailing Address - Street 2:
Mailing Address - City:WAUZEKA
Mailing Address - State:WI
Mailing Address - Zip Code:53826-8610
Mailing Address - Country:US
Mailing Address - Phone:608-875-1207
Mailing Address - Fax:
Practice Address - Street 1:33455 INDUSTRIAL DR LOT 38
Practice Address - Street 2:
Practice Address - City:WAUZEKA
Practice Address - State:WI
Practice Address - Zip Code:53826-8610
Practice Address - Country:US
Practice Address - Phone:608-875-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI322719-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty