Provider Demographics
NPI:1629409388
Name:VAN BOMMEL, AISHA
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:VAN BOMMEL
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:N51W16911 OLD HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-7502
Mailing Address - Country:US
Mailing Address - Phone:262-373-0150
Mailing Address - Fax:262-718-7677
Practice Address - Street 1:N51W16911 OLD HICKORY RD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-7502
Practice Address - Country:US
Practice Address - Phone:262-373-0150
Practice Address - Fax:262-718-7677
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI149905-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health