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General NPI Number Information
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NPI Number | 1245209196
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Entity Type | Organization
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Legal Business Name | INDEPENDENT NURSE
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11226 W JANESVILLE RD
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City | HALES CORNERS
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State | WI
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Zip | 53130-2401
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Country | US
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Telephone | 414-525-0515
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Fax |
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Provider Business Mailing Address
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Address Line | 11226 W JANESVILLE RD
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City | HALES CORNERS
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State | WI
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Zip | 53130-2401
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Country | US
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Telephone | 414-525-0515
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Fax |
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Authorized Official
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Title or Position | VENTILATOR NURSE
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Name | MS. SHARON MARIE BLOMDAHL
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Credential | LPN/RCS
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Telephone | 414-525-0515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 33596031
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License Number State | WI
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