Provider Demographics
NPI:1174163141
Name:DAMASCHKE, KENDRA J (RN)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:J
Last Name:DAMASCHKE
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 1:719 BURR OAK CT
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1229
Mailing Address - Country:US
Mailing Address - Phone:262-725-2295
Mailing Address - Fax:
Practice Address - Street 1:719 BURR OAK CT
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-1229
Practice Address - Country:US
Practice Address - Phone:262-725-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI250232-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health