Healthcare Provider Details

I. General information

NPI: 1356782015
Provider Name (Legal Business Name): U.S. DEPARTMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 E BENNETT AVE
MILWAUKEE WI
53207-2962
US

IV. Provider business mailing address

1907 E BENNETT AVE
MILWAUKEE WI
53207-2962
US

V. Phone/Fax

Practice location:
  • Phone: 414-202-3941
  • Fax:
Mailing address:
  • Phone: 414-202-3941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number0000
License Number StateWI

VIII. Authorized Official

Name: MICHELLE MEZAROS
Title or Position: HUMAN RESOURCES SPECIALIST
Credential: RN, MSN
Phone: 414-384-2000