Provider Demographics
NPI:1275596991
Name:PARHAM, ARETHA LATRISE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MISS
First Name:ARETHA
Middle Name:LATRISE
Last Name:PARHAM
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 VALLEY EDGE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-8926
Mailing Address - Country:US
Mailing Address - Phone:608-242-8995
Mailing Address - Fax:
Practice Address - Street 1:5305 VALLEY EDGE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-8926
Practice Address - Country:US
Practice Address - Phone:608-242-8995
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38207700OtherPROVIDER NUMBER