Provider Demographics
NPI:1154303287
Name:ENLUND, JIM (NHA)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:ENLUND
Suffix:
Gender:M
Credentials:NHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-3703
Mailing Address - Country:US
Mailing Address - Phone:414-607-4362
Mailing Address - Fax:414-607-4502
Practice Address - Street 1:3023 S 84TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-3703
Practice Address - Country:US
Practice Address - Phone:414-607-4362
Practice Address - Fax:414-607-4502
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2196376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator