Individual
MS. DENISE MATLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
5734 N 65TH ST, MILWAUKEE, WI 53218-2329
(414) 534-1493
(419) 828-6586
Mailing address
5734 N 65TH ST, MILWAUKEE, WI 53218-2329
(414) 534-1493
(419) 828-6586
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39970600
—
WI
Enumeration date
07/28/2007
Last updated
07/28/2007
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