Organization
PDN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER WYCKOFF (RN)
(414) 458-3179
Entity
Organization
Contact information
Practice address
708 HAWTHORNE AVE UPPR, SOUTH MILWAUKEE, WI 53172-1734
(414) 458-3179
Mailing address
708 HAWTHORNE AVE UPPR, SOUTH MILWAUKEE, WI 53172-1734
(414) 458-3179
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
16513630
WI
Other
Enumeration date
02/18/2015
Last updated
02/18/2015
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