MEDICARE: MRS. REBECCA KAMPERSCHROER NICKELS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1602-023	WI
2	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164484747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA KAMPERSCHROER NICKELS PA

Provider Business Mailing Address
First Line	:	PO BOX 735044
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5044
Country	:	US
Telephone Number	:	414-858-2200
Fax Number	:	414-858-2230

Provider Business Practice Location Address
First Line	:	3237 S 16TH STREET
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-4526
Country	:	US
Telephone Number	:	414-647-5165
Fax Number	:	414-858-2230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	09/17/2024

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