Healthcare Provider Details

I. General information

NPI: 1396396701
Provider Name (Legal Business Name): MS. KAREN SUMLIN-GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9183 N 76TH ST
MILWAUKEE WI
53223-1905
US

IV. Provider business mailing address

9183 N 76TH ST
MILWAUKEE WI
53223-1905
US

V. Phone/Fax

Practice location:
  • Phone: 414-357-8060
  • Fax: 855-515-7249
Mailing address:
  • Phone: 414-517-1065
  • Fax: 855-515-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: