Healthcare Provider Details

I. General information

NPI: 1700617776
Provider Name (Legal Business Name): BELINDA EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4317 N 62ND ST
MILWAUKEE WI
53216-1218
US

IV. Provider business mailing address

4317 N 62ND ST
MILWAUKEE WI
53216-1218
US

V. Phone/Fax

Practice location:
  • Phone: 414-553-7993
  • Fax:
Mailing address:
  • Phone: 414-553-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number152036
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: