MEDICARE: MRS. SEUNG-BAE N/A CUMMINGS R.N.

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	149677-30	WI

General Provider Information

NPI Number	:	1609149426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SEUNG-BAE N/A CUMMINGS R.N.

Provider Business Mailing Address
First Line	:	2976 N FARWELL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3304
Country	:	US
Telephone Number	:	414-712-4982
Fax Number	:

Provider Business Practice Location Address
First Line	:	2976 N FARWELL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3304
Country	:	US
Telephone Number	:	414-712-4982
Fax Number	:

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

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	02/10/2012

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