Healthcare Provider Details

I. General information

NPI: 1467979732
Provider Name (Legal Business Name): RONALD KABAALE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5443 N 13TH STREET APT 4
MILWAUKEE WI
53209-5100
US

IV. Provider business mailing address

5443 N 13TH ST APT 4
MILWAUKEE WI
53209-5100
US

V. Phone/Fax

Practice location:
  • Phone: 414-797-4803
  • Fax:
Mailing address:
  • Phone: 414-797-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number176839
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: