Provider Demographics
NPI:1598424889
Name:NEMBHARD, OPALLETA (RN)
Entity Type:Individual
Prefix:
First Name:OPALLETA
Middle Name:
Last Name:NEMBHARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8828 W PALMETTO AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-5010
Mailing Address - Country:US
Mailing Address - Phone:414-975-0537
Mailing Address - Fax:
Practice Address - Street 1:8828 W PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-5010
Practice Address - Country:US
Practice Address - Phone:414-975-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251035163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse