Provider Demographics
NPI:1699162883
Name:TALATZKO, CALLIE (RN)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:TALATZKO
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 1:1638 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1826
Mailing Address - Country:US
Mailing Address - Phone:414-587-9393
Mailing Address - Fax:
Practice Address - Street 1:1638 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172
Practice Address - Country:US
Practice Address - Phone:414-587-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-25
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI198387-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse