Healthcare Provider Details

I. General information

NPI: 1487050100
Provider Name (Legal Business Name): MISS MERCY A ENYEJI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 S CHASE AVE
MILWAUKEE WI
53207-6407
US

IV. Provider business mailing address

2950 S CHASE AVE
MILWAUKEE WI
53207-6407
US

V. Phone/Fax

Practice location:
  • Phone: 410-831-5341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA10642
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20262-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: