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General NPI Number Information
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NPI Number | 1124865092
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Entity Type | Organization
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Legal Business Name | NEPHROLOGY TELEHEALTH LLC
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Dates
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Enumeration Date | 07/09/2024
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 1260 SENTRY DR STE 140
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City | WAUKESHA
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State | WI
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Zip | 53186-5990
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Country | US
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Telephone | 262-524-1024
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Fax |
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Provider Business Mailing Address
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Address Line | 1260 SENTRY DR STE 140
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City | WAUKESHA
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State | WI
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Zip | 53186-5990
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Country | US
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Telephone | 262-524-1024
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JENNIFER CHRISTMAN
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Credential | MBA
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Telephone | 262-524-1024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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