Individual
MISS TIA M KIRKSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4073 N 51ST BLVD, MILWAUKEE, WI 53216-1374
(414) 610-3439
Mailing address
4073 N 51ST BLVD, MILWAUKEE, WI 53216-1374
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
312085-031
WI
Other
Enumeration date
01/10/2012
Last updated
01/10/2012
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