Provider Demographics
NPI:1902142359
Name:DR-BR SUPPORTIVE CARE
Entity Type:Organization
Organization Name:DR-BR SUPPORTIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAWYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:414-554-0518
Mailing Address - Street 1:4203 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6940
Mailing Address - Country:US
Mailing Address - Phone:414-665-0518
Mailing Address - Fax:
Practice Address - Street 1:4203 N 14TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6940
Practice Address - Country:US
Practice Address - Phone:414-665-0518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care