Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor |
NPI | 1063942985 |
---|---|
Provider Name | Deafrica Milton Alexander |
First Address | Milwaukee, WI 53212-3714 |
Second Address | Milwaukee, WI 53216-2728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2017 |
Last Update Date | 13/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
82-1136184 | (05) | WI |