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NPI Code Detail

MEDICARE: CHRISTA ANNE OVERFORS COTA

MEDICARE: CHRISTA ANNE OVERFORS COTA
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
1172V00000XCommunity Health Worker4604027WI

General Provider Information

NPI Number : 1316113566
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTA ANNE OVERFORS COTA
Provider Business Mailing Address
First Line : 2117 N 56TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-1027
Country : US
Telephone Number : 414-364-4012
Fax Number :
Provider Business Practice Location Address
First Line : 2117 N 56TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-1027
Country : US
Telephone Number : 414-364-4012
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2008
Last Update Date : 05/07/2008

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Directions to “ CHRISTA ANNE OVERFORS COTA” Practice Location

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