Healthcare Provider Details

I. General information

NPI: 1639833445
Provider Name (Legal Business Name): ADRIANA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 S 19TH ST
MILWAUKEE WI
53215-4914
US

IV. Provider business mailing address

3460 S 19TH ST
MILWAUKEE WI
53215-4914
US

V. Phone/Fax

Practice location:
  • Phone: 414-779-0097
  • Fax:
Mailing address:
  • Phone: 414-779-0097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number249433
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number249433
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number249433
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: