MEDICARE: MISS CARLISSA WASHINGTON CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		WI

General Provider Information

NPI Number	:	1144091794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CARLISSA WASHINGTON CNA

Provider Business Mailing Address
First Line	:	3412 N 58TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2845
Country	:	US
Telephone Number	:	414-364-5432
Fax Number	:

Provider Business Practice Location Address
First Line	:	3412 N 58TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2845
Country	:	US
Telephone Number	:	414-364-5432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2024
Last Update Date	:	01/12/2024

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Directions to “ MISS CARLISSA WASHINGTON CNA” Practice Location

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