Provider Demographics
NPI:1912517475
Name:OCAMPO, ESTEFANIA L
Entity type:Individual
Prefix:MRS
First Name:ESTEFANIA
Middle Name:L
Last Name:OCAMPO
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 1:1318 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-3375
Mailing Address - Country:US
Mailing Address - Phone:262-210-4003
Mailing Address - Fax:
Practice Address - Street 1:1512 S UNION ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2646
Practice Address - Country:US
Practice Address - Phone:414-249-3547
Practice Address - Fax:414-249-3957
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0016594311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home