Healthcare Provider Details

I. General information

NPI: 1699705335
Provider Name (Legal Business Name): ZABLOCKI VA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

329 N 114TH ST
WAUWATOSA WI
53226-4007
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax:
Mailing address:
  • Phone: 414-453-4928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number159-019
License Number StateWI

VIII. Authorized Official

Name: MRS. TAMRA LYNN RONDONE
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential: P.T.A.
Phone: 414-384-2000