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NPI Code Detail

MEDICARE: HAILEY JO GRISHAM-KERCH RN

MEDICARE:   HAILEY JO GRISHAM-KERCH  RN
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
1163WH0200XHome Health Registered Nurse1111673WI

General Provider Information

NPI Number : 1669288320
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAILEY JO GRISHAM-KERCH RN
Provider Business Mailing Address
First Line : 2800 N HOLTON ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-2522
Country : US
Telephone Number : 414-803-0320
Fax Number :
Provider Business Practice Location Address
First Line : 2800 N HOLTON ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-2522
Country : US
Telephone Number : 414-803-0320
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2024
Last Update Date : 12/09/2024

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Directions to “ HAILEY JO GRISHAM-KERCH RN” Practice Location

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