Provider Demographics
NPI:1811164924
Name:CLEMENT J. ZABLOCKI VA MEDICAL CENTER
Entity type:Organization
Organization Name:CLEMENT J. ZABLOCKI VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MISS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-259-1239
Mailing Address - Street 1:2172 N 63RD ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2026
Mailing Address - Country:US
Mailing Address - Phone:414-259-1239
Mailing Address - Fax:
Practice Address - Street 1:2172 N 63RD ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2026
Practice Address - Country:US
Practice Address - Phone:414-259-1239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
35045700251J00000X
WI35045700282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No251J00000XAgenciesNursing Care