Healthcare Provider Details

I. General information

NPI: 1679820294
Provider Name (Legal Business Name): LINDA LOUISE OCZUS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 E MARION ST APT 305
SHOREWOOD WI
53211-2064
US

IV. Provider business mailing address

1809 E MARION ST APT 305
SHOREWOOD WI
53211-2064
US

V. Phone/Fax

Practice location:
  • Phone: 414-698-3993
  • Fax:
Mailing address:
  • Phone: 414-698-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number94998
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: