1588847263 NPI number — HANNA MONICA WOMACK LICENSED PHYSICAL TH

Table of content: HANNA MONICA WOMACK LICENSED PHYSICAL TH (NPI 1588847263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588847263 NPI number — HANNA MONICA WOMACK LICENSED PHYSICAL TH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOMACK
Provider First Name:
HANNA
Provider Middle Name:
MONICA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICENSED PHYSICAL TH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RONKIEWICZ
Provider Other First Name:
HANNA
Provider Other Middle Name:
MONICA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICENSED PHYSICAL TH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588847263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
316 NORTH MILWAUKEE STREET
Provider Second Line Business Mailing Address:
SUITE 208 HERITAGE STAFFING CONSULTING
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53202-5803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-615-0665
Provider Business Mailing Address Fax Number:
414-615-0667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
316 NORTH MILWAUKEE STREET
Provider Second Line Business Practice Location Address:
SUITE 208 HERITAGE STAFFING CONSULTING
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53202-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-615-0665
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2007

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: 225200000X , with the licence number:  860019 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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