Individual
KENYATTA BRIGCHELLE VACCARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3113 E WASHINGTON AVE, MADISON, WI 53704-4330
(608) 416-5777
Mailing address
1517 TRAILSWAY APT 3, MADISON, WI 53704-2934
(608) 516-8696
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
311553-31
WI
Other
Enumeration date
02/09/2023
Last updated
02/09/2023
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