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NPI Code Detail

MEDICARE: MR. EDWARD J WASIE NP

MEDICARE: MR. EDWARD J WASIE NP
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
1363L00000XNurse Practitioner6719WI
2363L00000XNurse Practitioner4704202513MI
3363LF0000XFamily Nurse Practitioner6719WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
30829560001OTHERMIMEDICARE DME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2EW202513OTHERMIBCBS LICENSE NUMBER

General Provider Information

NPI Number : 1538252572
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDWARD J WASIE NP
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 920-746-7200
Fax Number :
Provider Business Practice Location Address
First Line : 1910 ALABAMA ST
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-3532
Country : US
Telephone Number : 920-746-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 11/17/2025

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