Organization
CODDLE CARE PNCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA JOHNSON (CHIEF EXECUTIVE OFFICER)
(414) 446-5578
Entity
Organization
Contact information
Practice address
6051 W BROWN DEER RD STE 105, BROWN DEER, WI 53223-2263
(414) 446-5578
(414) 446-5855
Mailing address
6051 W BROWN DEER RD STE 105, BROWN DEER, WI 53223-2263
(414) 446-5578
(414) 446-5855
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
—
—
163WC1500X
Community Health Registered Nurse
—
—
163WC1600X
Continuing Education/Staff Development Registered Nurse
—
—
163WI0500X
Infusion Therapy Registered Nurse
—
—
163WM0102X
Maternal Newborn Registered Nurse
—
—
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
07/08/2021
Last updated
07/28/2021
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