Provider Demographics
NPI:1154183101
Name:ROSAS KONTOWSKI, AZALIA G (LPN)
Entity type:Individual
Prefix:
First Name:AZALIA
Middle Name:G
Last Name:ROSAS KONTOWSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 MILLER PARK WAY STE 16001610
Mailing Address - Street 2:
Mailing Address - City:WEST MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3604
Mailing Address - Country:US
Mailing Address - Phone:414-306-7120
Mailing Address - Fax:
Practice Address - Street 1:1610 MILLER PARK WAY STE 16001610
Practice Address - Street 2:
Practice Address - City:WEST MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3604
Practice Address - Country:US
Practice Address - Phone:141-430-6712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI327544-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse