Individual
ROENA ANGELA WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ADULT FAMILY HOME
Contact information
Practice address
4910 63RD AVE, KENOSHA, WI 53144-1709
(262) 351-5955
(262) 222-2399
Mailing address
4910 63RD AVE, KENOSHA, WI 53144-1709
(262) 351-5955
(262) 222-2399
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
0019382
WI
Other
Enumeration date
10/28/2024
Last updated
10/28/2024
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