Individual
MISS TENISHA DANIELLE MAXEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5296 N. 73RD ST., MILWAUKEE, WI 53218
(414) 234-0619
Mailing address
5296 N 73RD ST, MILWAUKEE, WI 53218-2821
(414) 234-0619
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
309799-031
WV
Other
Enumeration date
11/25/2009
Last updated
11/25/2009
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