MEDICARE: TREANACE WHITE RN

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	164144-030	WI

General Provider Information

NPI Number	:	1386877975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREANACE WHITE RN

Provider Business Mailing Address
First Line	:	5443 N 92ND ST UNIT D
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-3490
Country	:	US
Telephone Number	:	414-416-6794
Fax Number	:

Provider Business Practice Location Address
First Line	:	5443 N 92ND ST UNIT D
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-3490
Country	:	US
Telephone Number	:	414-416-6794
Fax Number	:

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

Provider Enumeration Date	:	08/28/2009
Last Update Date	:	08/28/2009

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