Provider Demographics
NPI:1619202546
Name:AURORA HEALTH CARE WIC
Entity Type:Organization
Organization Name:AURORA HEALTH CARE WIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, WIC PROGRAM
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:AGNELLO
Authorized Official - Suffix:
Authorized Official - Credentials:RD CD
Authorized Official - Phone:414-219-3344
Mailing Address - Street 1:1218 W KILBOURN AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1330
Mailing Address - Country:US
Mailing Address - Phone:414-219-3210
Mailing Address - Fax:
Practice Address - Street 1:1218 W KILBOURN AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1330
Practice Address - Country:US
Practice Address - Phone:414-219-3210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI251K00000XOtherTAXONOMY