Individual
ANGELA M VENTURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4931 68TH ST, KENOSHA, WI 53142-1616
(262) 654-4757
Mailing address
4931 68TH ST, KENOSHA, WI 53142-1616
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
746-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40008600
—
WI
Enumeration date
11/30/2009
Last updated
11/30/2009
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