MEDICARE: DINA REPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	225092-30	WI

General Provider Information

NPI Number	:	1497113054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINA REPA

Provider Business Mailing Address
First Line	:	1330 MENOMONEE AVE
Second Line	:
City	:	SOUTH MILWAUKEE
State	:	WI
Zip	:	53172-3014
Country	:	US
Telephone Number	:	414-803-5364
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 MENOMONEE AVE
Second Line	:
City	:	SOUTH MILWAUKEE
State	:	WI
Zip	:	53172-3014
Country	:	US
Telephone Number	:	414-803-5364
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	02/10/2016

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