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General NPI Number Information
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NPI Number | 1245574714
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Entity Type | Organization
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Legal Business Name | NISA INCORPORATED
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 10213A W FOND DU LAC AVE 128
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City | MILWAUKEE
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State | WI
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Zip | 53224-5171
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Country | US
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Telephone | 262-412-9728
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 18488
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City | MILWAUKEE
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State | WI
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Zip | 53218
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Country | US
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Telephone | 262-412-9728
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHAYLA DANIELLE RUBBANI
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Credential |
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Telephone | 262-412-9728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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