MEDICARE: REGINALD CEPHUS

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	363LF0000X	Family Nurse Practitioner	F06231343	WI
2	163W00000X	Registered Nurse	219456-30	WI

General Provider Information

NPI Number	:	1598214223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINALD CEPHUS

Provider Business Mailing Address
First Line	:	4821 N 64TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4020
Country	:	US
Telephone Number	:	262-450-5045
Fax Number	:

Provider Business Practice Location Address
First Line	:	4821 N 64TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4020
Country	:	US
Telephone Number	:	262-450-5045
Fax Number	:

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

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	10/28/2025

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Directions to “ REGINALD CEPHUS ” Practice Location

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