Healthcare Provider Details

I. General information

NPI: 1144366337
Provider Name (Legal Business Name): VETERANS HEALTH AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 N PROSPECT AVE APARTMENT 811
MILWAUKEE WI
53202-1973
US

IV. Provider business mailing address

1732 N PROSPECT AVE APARTMENT 811
MILWAUKEE WI
53202-1973
US

V. Phone/Fax

Practice location:
  • Phone: 608-658-8678
  • Fax:
Mailing address:
  • Phone: 608-658-8678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. JILLIAN ABBY TAXMAN
Title or Position: OCCUPATIONAL THERAPIST
Credential: B.S.
Phone: 608-658-8678