MEDICARE: MS. SONIA GREENGRASS 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	151039	WI

General Provider Information

NPI Number	:	1730597550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SONIA GREENGRASS RN

Provider Business Mailing Address
First Line	:	2654 S 16TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-3002
Country	:	US
Telephone Number	:	414-418-1802
Fax Number	:

Provider Business Practice Location Address
First Line	:	2654 S 16TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-3002
Country	:	US
Telephone Number	:	414-418-1802
Fax Number	:

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

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	07/24/2014

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