Provider Demographics
NPI:1770968802
Name:NABORS, KALEATHA
Entity type:Individual
Prefix:
First Name:KALEATHA
Middle Name:
Last Name:NABORS
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 1:6833 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3900
Mailing Address - Country:US
Mailing Address - Phone:414-699-4636
Mailing Address - Fax:414-449-9912
Practice Address - Street 1:6833 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3900
Practice Address - Country:US
Practice Address - Phone:414-699-4636
Practice Address - Fax:414-449-9912
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator