Healthcare Provider Details

I. General information

NPI: 1124726963
Provider Name (Legal Business Name): TOUCHED BY GRACE OF MILWAUKEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N VEL R PHILLIPS AVE
MILWAUKEE WI
53212-2713
US

IV. Provider business mailing address

2501 N VEL R PHILLIPS AVE
MILWAUKEE WI
53212-2713
US

V. Phone/Fax

Practice location:
  • Phone: 334-470-4994
  • Fax:
Mailing address:
  • Phone: 334-470-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: WINDY CARTER
Title or Position: REGISTERED NURSE
Credential:
Phone: 334-470-4994