Healthcare Provider Details

I. General information

NPI: 1740513399
Provider Name (Legal Business Name): BETTY NZEE WALUSAYI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4922 N 85TH ST
MILWAUKEE WI
53225-4209
US

IV. Provider business mailing address

4922 N 85TH ST
MILWAUKEE WI
53225-4209
US

V. Phone/Fax

Practice location:
  • Phone: 414-507-1119
  • Fax:
Mailing address:
  • Phone: 414-507-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number88025-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number88025-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: