=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215114400
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEMITASHI VENITA AUSTIN LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2008
-----------------------------------------------------
Last Update Date | 01/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7480 N 86TH ST. UNIT D
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-446-4318
-----------------------------------------------------
Fax | 414-446-4318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7480 N 86TH ST. UNIT D
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-446-4318
-----------------------------------------------------
Fax | 414-446-4318
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------