1073798823 NPI number — MS. VIOLETTA PATRIEA JOSEPH PCW CERTIFICATION

Table of content: MS. VIOLETTA PATRIEA JOSEPH PCW CERTIFICATION (NPI 1073798823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073798823 NPI number — MS. VIOLETTA PATRIEA JOSEPH PCW CERTIFICATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOSEPH
Provider First Name:
VIOLETTA
Provider Middle Name:
PATRIEA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PCW CERTIFICATION
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUMAS
Provider Other First Name:
VIOLETTA
Provider Other Middle Name:
PATRICA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073798823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2117 N 42ND STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53208-2117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-873-6263
Provider Business Mailing Address Fax Number:
414-873-6263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2117 N 42ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53208-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-873-6263
Provider Business Practice Location Address Fax Number:
414-873-6263
Provider Enumeration Date:
12/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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