Individual
CHRISTINA PETRA MATIAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7645 10TH AVE, KENOSHA, WI 53143-6044
(847) 401-8609
Mailing address
7645 10TH AVE, KENOSHA, WI 53143-6044
(847) 401-8609
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
222847
WI
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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