Provider Demographics
NPI:1114228202
Name:DJIGUIBA, PATRICE NICOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:NICOLE
Last Name:DJIGUIBA
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 1:6531 N 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-5715
Mailing Address - Country:US
Mailing Address - Phone:414-628-4679
Mailing Address - Fax:
Practice Address - Street 1:6531 N 68TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-5715
Practice Address - Country:US
Practice Address - Phone:414-628-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI166513-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse