Provider Demographics
NPI:1902579097
Name:BANKHEAD ANTWI, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:BANKHEAD ANTWI
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:W175N11117 STONEWOOD DR STE 290
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6508
Mailing Address - Country:US
Mailing Address - Phone:347-398-7923
Mailing Address - Fax:
Practice Address - Street 1:W175N11117 STONEWOOD DR STE 290
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6508
Practice Address - Country:US
Practice Address - Phone:347-398-7923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI853955564Medicaid