Provider Demographics
NPI:1306534631
Name:GHAFFAR, MADIHA
Entity type:Individual
Prefix:
First Name:MADIHA
Middle Name:
Last Name:GHAFFAR
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 1:8219 S PRESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-7102
Mailing Address - Country:US
Mailing Address - Phone:414-418-6452
Mailing Address - Fax:
Practice Address - Street 1:3655 S DEER CREEK PKWY
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5354
Practice Address - Country:US
Practice Address - Phone:414-418-6452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI325073-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty