Provider Demographics
NPI:1770776437
Name:MENAMIN, ROBERT P (RN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:P
Last Name:MENAMIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 JENNA DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-8312
Mailing Address - Country:US
Mailing Address - Phone:608-845-5933
Mailing Address - Fax:
Practice Address - Street 1:109 JENNA DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-8312
Practice Address - Country:US
Practice Address - Phone:608-845-5933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46991-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39829700Medicaid