Healthcare Provider Details

I. General information

NPI: 1154183101
Provider Name (Legal Business Name): AZALIA G ROSAS KONTOWSKI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 MILLER PARK WAY STE 16001610
WEST MILWAUKEE WI
53214-3604
US

IV. Provider business mailing address

1610 MILLER PARK WAY STE 16001610
WEST MILWAUKEE WI
53214-3604
US

V. Phone/Fax

Practice location:
  • Phone: 141-430-6712
  • Fax:
Mailing address:
  • Phone: 414-306-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number327544-31
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: