Healthcare Provider Details

I. General information

NPI: 1568876670
Provider Name (Legal Business Name): MS. COMIKIA SHANTA PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 N 40TH ST
MILWAUKEE WI
53216-2519
US

IV. Provider business mailing address

3936 N 40TH ST
MILWAUKEE WI
53216-2519
US

V. Phone/Fax

Practice location:
  • Phone: 414-550-4007
  • Fax: 414-445-6280
Mailing address:
  • Phone: 414-550-4007
  • Fax: 414-445-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: