MEDICARE: HAVILAH A NORMINGTON RN, MSN

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	364S00000X	Clinical Nurse Specialist	157854-30	WI

General Provider Information

NPI Number	:	1700023124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAVILAH A NORMINGTON RN, MSN

Provider Business Mailing Address
First Line	:	2301 SUN VALLEY DR
Second Line	:	SUITE 200
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2318
Country	:	US
Telephone Number	:	262-646-4162
Fax Number	:	262-646-2498

Provider Business Practice Location Address
First Line	:	2301 SUN VALLEY DR
Second Line	:	SUITE 200
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2318
Country	:	US
Telephone Number	:	262-646-4162
Fax Number	:	262-646-2498

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

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	01/08/2009

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