Healthcare Provider Details

I. General information

NPI: 1578516118
Provider Name (Legal Business Name): INDEPENDENT NURSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 COPERNICUS WAY
MADISON WI
53718-3096
US

IV. Provider business mailing address

609 COPERNICUS WAY
MADISON WI
53718-3096
US

V. Phone/Fax

Practice location:
  • Phone: 608-467-8367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ELIZABETH J GARWO
Title or Position: LPN
Credential: 164W00000X
Phone: 608-467-8367