Healthcare Provider Details

I. General information

NPI: 1023703816
Provider Name (Legal Business Name): VERONICA NAKHLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W216N5506 ADAMDALE DR
MENOMONEE FALLS WI
53051-6271
US

IV. Provider business mailing address

W216N5506 ADAMDALE DR
MENOMONEE FALLS WI
53051-6271
US

V. Phone/Fax

Practice location:
  • Phone: 414-306-9936
  • Fax:
Mailing address:
  • Phone: 414-306-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6001281-15
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: