Healthcare Provider Details

I. General information

NPI: 1154040723
Provider Name (Legal Business Name): LINDA RODRIGUEZ BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6656 N 84TH ST
MILWAUKEE WI
53224-5406
US

IV. Provider business mailing address

6656 N 84TH ST
MILWAUKEE WI
53224-5406
US

V. Phone/Fax

Practice location:
  • Phone: 414-531-3736
  • Fax:
Mailing address:
  • Phone: 414-531-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: