Individual
AEMELIA ANNE TALLEN-WHITED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
6308 8TH AVE, SUITE 1040, KENOSHA, WI 53143-5031
(262) 653-5437
(262) 656-3415
Mailing address
6308 8TH AVE, SUITE 1040, KENOSHA, WI 53143-5031
(262) 653-5437
(262) 656-3415
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4695-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831402734
—
WI
01
—
4695-33
LICENSE
WI
Enumeration date
07/20/2010
Last updated
03/04/2013
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