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General NPI Number Information
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NPI Number | 1609171453
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Entity Type | Organization
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Legal Business Name | STAT ACCESS
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Dates
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Enumeration Date | 01/25/2011
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 3429 E ALLERTON AVE
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City | CUDAHY
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State | WI
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Zip | 53110-1017
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Country | US
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Telephone | 414-405-9055
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 370646
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City | MILWAUKEE
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State | WI
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Zip | 53237-1746
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER-PARTNER/ REGISTERED NURSE
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Name | MR. DOUGLAS JAMES BYSTREK
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Credential | RN
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Telephone | 414-405-9055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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