Provider Demographics
NPI:1528367992
Name:HAFEMANN, ERIKA MILDRED (LPN)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:MILDRED
Last Name:HAFEMANN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-3522
Mailing Address - Country:US
Mailing Address - Phone:414-379-0198
Mailing Address - Fax:
Practice Address - Street 1:1316 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-3522
Practice Address - Country:US
Practice Address - Phone:414-379-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI307282-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse