Most Relevant Information
Provider Data
| NPI Number: | 1003279332 |
| Provider Name: | PENNY JO WALDUM RN |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 2043010 |
Most Important Dates
| Enumeration Date: | 04/04/2016 |
| Last Updated: | 01/30/2024 |
Provider Practice Location
2222 E 5TH ST
SUPERIOR
WI
548803709
Practice Location Phone/Fax
| Phone: | 7153921955 |
| Fax: | 7153921935 |
Provider Mailing Location
2222 E 5TH ST
SUPERIOR
WI
548803709
Provider Mailing Phone/Fax
| Phone: | 7153921955 |
| Fax: | 7153921935 |