Individual
AXIA ANTOINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2609 N 37TH ST, MILWAUKEE, WI 53210-2528
(414) 233-9328
Mailing address
2609 N 37TH ST, MILWAUKEE, WI 53210-2528
(414) 233-9328
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
322320-31
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
322320-31
LICENSE PRACTICAL NURSE
WI
Enumeration date
06/30/2019
Last updated
06/30/2019
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