Healthcare Provider Details

I. General information

NPI: 1902717200
Provider Name (Legal Business Name): MRS. CHARAMA KATHLEEN SLADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 N 80TH ST
MILWAUKEE WI
53223-5506
US

IV. Provider business mailing address

7230 N RANGE LINE RD
GLENDALE WI
53209-2026
US

V. Phone/Fax

Practice location:
  • Phone: 414-393-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1621663-0
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: