Healthcare Provider Details

I. General information

NPI: 1477177079
Provider Name (Legal Business Name): CHANELLE ANSHELA CAUSEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2020
Last Update Date: 05/31/2020
Certification Date: 05/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 N 57TH ST
MILWAUKEE WI
53216-2216
US

IV. Provider business mailing address

3840 N 57TH ST
MILWAUKEE WI
53216-2216
US

V. Phone/Fax

Practice location:
  • Phone: 414-640-5385
  • Fax:
Mailing address:
  • Phone: 414-640-5385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number229440
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: