Provider Demographics
NPI:1417301565
Name:AGUILAR AUDEO, ROSAOLEANA
Entity Type:Individual
Prefix:
First Name:ROSAOLEANA
Middle Name:
Last Name:AGUILAR AUDEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-2957
Mailing Address - Country:US
Mailing Address - Phone:414-647-7466
Mailing Address - Fax:414-527-7630
Practice Address - Street 1:209 W ORCHARD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2957
Practice Address - Country:US
Practice Address - Phone:414-647-7466
Practice Address - Fax:414-527-7630
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6695-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily