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General NPI Number Information
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NPI Number | 1245643725
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Entity Type | Organization
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Legal Business Name | JENNINE
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 717 LAND PL
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City | MILWAUKEE
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State | WI
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Zip | 53205-2358
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Country | US
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Telephone | 414-795-5753
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Fax |
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Provider Business Mailing Address
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Address Line | 717 LAND PL
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City | MILWAUKEE
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State | WI
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Zip | 53205-2358
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Country | US
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Telephone | 414-795-5753
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Fax |
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Authorized Official
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Title or Position | INDEPENDENT CARE GIVER
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Name | MRS. JENNINE ANTIONETTE EASLEY
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Credential | REGISTERED NURSE
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Telephone | 414-795-5753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 200568-30
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License Number State | WI
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