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General NPI Number Information
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NPI Number | 1821277310
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Entity Type | Individual
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Provider Name | ROSALIE C MACKAY COTA
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Gender | Female
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 111 W MICHIGAN ST PROSTEP/EXTENDICARE HEALTH SERVICES
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City | MILWAUKEE
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State | WI
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Zip | 53203
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Country | US
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Telephone | 570-724-5270
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Fax | 570-724-5276
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Provider Business Mailing Address
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Address Line | 111 W MICHIGAN ST PROSTEP/EXTENDICARE HEALTH SERVICES
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City | MILWAUKEE
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State | WI
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Zip | 53203
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Country | US
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Telephone | 570-724-5270
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Fax | 570-724-5276
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | OP006475
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License Number State | PA
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