Provider Demographics
NPI:1003232570
Name:ATTERBURY, ANTOINETTE
Entity Type:Individual
Prefix:MISS
First Name:ANTOINETTE
Middle Name:
Last Name:ATTERBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1725
Mailing Address - Country:US
Mailing Address - Phone:262-501-8341
Mailing Address - Fax:414-873-0695
Practice Address - Street 1:4239 N 38TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1725
Practice Address - Country:US
Practice Address - Phone:262-501-8341
Practice Address - Fax:414-873-0695
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-08
Last Update Date:2014-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker