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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
EDNA M HUDSON-KINZEY MSN ED, RN (PROVIDER)
(414) 522-0417
Entity
Organization

Contact information

Practice address
9235 W CAPITOL DR STE LL1, MILWAUKEE, WI 53222-1567
(414) 522-0455
Mailing address
12605 W NORTH AVE # 282, BROOKFIELD, WI 53005-4629
(414) 522-0455
(414) 509-6747

Taxonomy

Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
041338963
IL
163WH0200X
Home Health Registered Nurse
Primary
124990
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
020368826365001
IL
05
100067593
WI
Enumeration date
07/24/2017
Last updated
01/05/2021
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