Provider Demographics
NPI:1083091839
Name:TADYCH, CAMILLE (RN)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:TADYCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 W SILVER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3300
Mailing Address - Country:US
Mailing Address - Phone:414-527-6940
Mailing Address - Fax:414-527-6941
Practice Address - Street 1:5151 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3300
Practice Address - Country:US
Practice Address - Phone:414-527-6940
Practice Address - Fax:414-527-6941
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
70082-30171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator