Healthcare Provider Details

I. General information

NPI: 1811572969
Provider Name (Legal Business Name): DENISE CARADINE CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 W FOND DU LAC AVE
MILWAUKEE WI
53218-2604
US

IV. Provider business mailing address

9310 N 107TH ST # 105
MILWAUKEE WI
53224-1121
US

V. Phone/Fax

Practice location:
  • Phone: 414-252-2737
  • Fax:
Mailing address:
  • Phone: 414-252-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: