Provider Demographics
NPI:1669288320
Name:GRISHAM-KERCH, HAILEY JO (RN)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:JO
Last Name:GRISHAM-KERCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N HOLTON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2522
Mailing Address - Country:US
Mailing Address - Phone:414-803-0320
Mailing Address - Fax:
Practice Address - Street 1:2800 N HOLTON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2522
Practice Address - Country:US
Practice Address - Phone:414-803-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1111673163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health