MEDICARE: INDEPENDENT NURSE

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	314000000X	Skilled Nursing Facility		WI

General Provider Information

NPI Number	:	1649464645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT NURSE

Provider Business Mailing Address
First Line	:	1919 N 19TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1547
Country	:	US
Telephone Number	:	414-933-7207
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 N 19TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1547
Country	:	US
Telephone Number	:	414-933-7207
Fax Number	:

Authorized Official
Title or Position	:	NURSE
Name	:	URWONDA S JONES
Credential	:	RN
Telephone Number	:	414-933-7207

Provider Enumeration Date	:	09/02/2007
Last Update Date	:	09/02/2007

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Directions to “INDEPENDENT NURSE ” Practice Location

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