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General NPI Number Information
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NPI Number | 1033837547
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Entity Type | Organization
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Legal Business Name | NUBIANCE INC
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | N103W14660 HAWKEYE CT
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City | GERMANTOWN
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State | WI
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Zip | 53022-5335
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Country | US
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Telephone | 262-327-0228
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Fax |
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Provider Business Mailing Address
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Address Line | N103W14660 HAWKEYE CT
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City | GERMANTOWN
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State | WI
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Zip | 53022-5335
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Country | US
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Telephone | 262-327-0228
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Fax |
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Authorized Official
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Title or Position | FOUNDING MEMBER
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Name | MRS. SHANTEL SHENISE BACCHUS
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Credential |
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Telephone | 262-327-0228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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