Provider Demographics
NPI:1811795255
Name:CHAIRSE, ANITRIA
Entity type:Individual
Prefix:
First Name:ANITRIA
Middle Name:
Last Name:CHAIRSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 W LISBON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2116
Mailing Address - Country:US
Mailing Address - Phone:414-803-9747
Mailing Address - Fax:866-201-2295
Practice Address - Street 1:1808 CREEK RD
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-2024
Practice Address - Country:US
Practice Address - Phone:414-803-9747
Practice Address - Fax:414-803-9747
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0019184374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide