MEDICARE: ANA NANCY PUMA RN, BSN

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	163W00000X	Registered Nurse	159603-30	WI

General Provider Information

NPI Number	:	1225417496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA NANCY PUMA RN, BSN

Provider Business Mailing Address
First Line	:	1532 W HOWARD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53221-1903
Country	:	US
Telephone Number	:	414-236-2306
Fax Number	:

Provider Business Practice Location Address
First Line	:	1532 W HOWARD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53221-1903
Country	:	US
Telephone Number	:	414-236-2306
Fax Number	:

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

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	05/21/2015

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