Healthcare Provider Details

I. General information

NPI: 1639552946
Provider Name (Legal Business Name): PATRICIA ROBINSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W KEEFE AVE
MILWAUKEE WI
53212-1462
US

IV. Provider business mailing address

408 W KEEFE AVE
MILWAUKEE WI
53212-1462
US

V. Phone/Fax

Practice location:
  • Phone: 414-264-1307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number31-307517
License Number StateWI

VIII. Authorized Official

Name: MISS PATRICIA PRINCESS ROBINSON
Title or Position: LPN
Credential:
Phone: 414-264-1307