Individual
CENTAJIAH CHANTALA STATEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5474 N 56TH ST, MILWAUKEE, WI 53218-3218
(414) 249-8974
Mailing address
5474 N 56TH ST, MILWAUKEE, WI 53218-3218
(414) 249-8974
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
390544
WI
Other
Enumeration date
09/01/2021
Last updated
09/01/2021
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