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Brody David Ilstrup
Student in an Organized Health Care Education/Training Program in Kenosha, Wisconsin
NPI 1578129102

Brody David Ilstrup is a Student in an Organized Health Care Education/Training Program based in Kenosha, WI. Brody David Ilstrup practices in Kenosha, WI. The NPI Number for Brody David Ilstrup is 1578129102 and holds a License No. (Wisconsin).

The current practice location address for Brody David Ilstrup is 2001 Alford Park Dr, Kenosha, WI and can be reached out via phone at 612-865-8656.

Location: 2001 Alford Park Dr, Kenosha, WI, 53140-1927
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1578129102
Provider Name
Brody David Ilstrup
Credential
Provider Entity Type
Individual
Gender
Male
Address
2001 Alford Park Dr, Kenosha, WI, 53140-1927
Phone Number
612-865-8656
Fax Number
Provider Enumeration Date
05/20/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
2001 Alford Park Dr
City
Kenosha
State
Wisconsin
Zip
53140-1927
Phone Number
612-865-8656
Fax Number
person
Provider Business Mailing Address Details
Address
2001 Alford Park Dr
City
Kenosha
State
Wisconsin
Zip
53140-1927
Phone Number
612-865-8656
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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