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General NPI Number Information
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NPI Number | 1588148423
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Entity Type | Individual
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Provider Name | CARRIE ANN TANG RN
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Gender | Female
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Dates
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Enumeration Date | 09/17/2018
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Last Update Date | 09/17/2018
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Provider Practice Location Address
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Address Line | 415 BLACK EARTH RD
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City | WALES
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State | WI
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Zip | 53183-9759
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Country | US
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Telephone | 262-968-1876
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Fax |
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Provider Business Mailing Address
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Address Line | 478 MAJESKIE DR
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City | PEWAUKEE
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State | WI
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Zip | 53072-6533
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Country | US
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Telephone | 262-352-2506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 112695
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License Number State | WI
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