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NPI Code Detail

MEDICARE: JOSE M AVILA RN, MSN, FNP-C

MEDICARE:   JOSE M AVILA  RN, MSN, FNP-C
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
1363L00000XNurse Practitioner1406-33WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720075716
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE M AVILA RN, MSN, FNP-C
Provider Business Mailing Address
First Line : 3301 W FOREST HOME AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-2843
Country : US
Telephone Number : 414-389-2377
Fax Number :
Provider Business Practice Location Address
First Line : 6030 W OKLAHOMA AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53219-4133
Country : US
Telephone Number : 414-546-2992
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 11/18/2021

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