Provider Demographics
NPI:1164602918
Name:VISITING NURSE ASSOCIATION OF WISCONSIN, INC.
Entity Type:Organization
Organization Name:VISITING NURSE ASSOCIATION OF WISCONSIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-329-4490
Mailing Address - Street 1:11333 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-3111
Mailing Address - Country:US
Mailing Address - Phone:414-327-2295
Mailing Address - Fax:
Practice Address - Street 1:11333 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-3111
Practice Address - Country:US
Practice Address - Phone:414-327-2295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISITING NURSE ASSOCIATION OF WISCONSIN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-09
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41516800Medicaid
WI000082260Medicare PIN