Provider Demographics
NPI:1114151487
Name:CNA PROFESSIONAL SERVICES, L.L.P.
Entity Type:Organization
Organization Name:CNA PROFESSIONAL SERVICES, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ETHEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:715-643-4068
Mailing Address - Street 1:E1602 1198TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOYCEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54725-9434
Mailing Address - Country:US
Mailing Address - Phone:715-643-4068
Mailing Address - Fax:715-643-6056
Practice Address - Street 1:E1602 1198TH AVE
Practice Address - Street 2:
Practice Address - City:BOYCEVILLE
Practice Address - State:WI
Practice Address - Zip Code:54725-9434
Practice Address - Country:US
Practice Address - Phone:715-643-4068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care