Healthcare Provider Details

I. General information

NPI: 1811164924
Provider Name (Legal Business Name): CLEMENT J. ZABLOCKI VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2172 N 63RD ST
WAUWATOSA WI
53213-2026
US

IV. Provider business mailing address

2172 N 63RD ST
WAUWATOSA WI
53213-2026
US

V. Phone/Fax

Practice location:
  • Phone: 414-259-1239
  • Fax:
Mailing address:
  • Phone: 414-259-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number35045700
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number35045700
License Number StateWI

VIII. Authorized Official

Name: MISS LYNETTE BOYD
Title or Position: LPN
Credential:
Phone: 414-259-1239