Healthcare Provider Details

I. General information

NPI: 1164647459
Provider Name (Legal Business Name): EMMA JEAN HUFF 91688
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 WAUNONA WAY
MADISON WI
53713-1525
US

IV. Provider business mailing address

5712 CLAREDON DR
FITCHBURG WI
53711-6423
US

V. Phone/Fax

Practice location:
  • Phone: 608-223-1452
  • Fax: 608-223-1459
Mailing address:
  • Phone: 608-274-7557
  • Fax: 608-299-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1968-27
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: