Provider Demographics
NPI:1740484583
Name:PASSANTE, CAROLINE ANN
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:ANN
Last Name:PASSANTE
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 1:10119 W VIENNA AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2352
Mailing Address - Country:US
Mailing Address - Phone:414-535-0079
Mailing Address - Fax:
Practice Address - Street 1:6414 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4917
Practice Address - Country:US
Practice Address - Phone:414-463-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator