Provider Demographics
NPI:1053565432
Name:KADIA, EVELYN A
Entity type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:A
Last Name:KADIA
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 1:10501 W BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2673
Mailing Address - Country:US
Mailing Address - Phone:414-354-5761
Mailing Address - Fax:414-354-7056
Practice Address - Street 1:10501 W BRADLEY RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-2673
Practice Address - Country:US
Practice Address - Phone:414-354-5761
Practice Address - Fax:414-354-7056
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165469-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse