1518195726 NPI number — MS. GINA MARIE WILLIAMS COTA

Table of content: MS. GINA MARIE WILLIAMS COTA (NPI 1518195726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518195726 NPI number — MS. GINA MARIE WILLIAMS COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
GINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
COTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KREMKAU
Provider Other First Name:
GINA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
COTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518195726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
JEWISH HOME AND CARE CENTER:THERAPY DEPARTMENT
Provider Second Line Business Mailing Address:
1414 N PROSPECT AVE
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53202-3018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-277-8854
Provider Business Mailing Address Fax Number:
844-284-6963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JEWISH HOME AND CARE CENTER:THERAPY DEPARTMENT
Provider Second Line Business Practice Location Address:
1414 N PROSPECT AVE
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53202-3018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-277-8854
Provider Business Practice Location Address Fax Number:
844-284-6963
Provider Enumeration Date:
06/25/2009

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: 174400000X , with the licence number:  4671027 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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