Provider Demographics
NPI:1164647459
Name:HUFF, EMMA JEAN (91688)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:JEAN
Last Name:HUFF
Suffix:
Gender:F
Credentials:91688
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 CLAREDON DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6423
Mailing Address - Country:US
Mailing Address - Phone:608-274-7557
Mailing Address - Fax:608-299-3797
Practice Address - Street 1:2620 WAUNONA WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1525
Practice Address - Country:US
Practice Address - Phone:608-223-1452
Practice Address - Fax:608-223-1459
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1968-27313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility