Healthcare Provider Details

I. General information

NPI: 1235759457
Provider Name (Legal Business Name): EMILY KATHRYN HANKA RESIDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 GRIFFIN ST E
AMERY WI
54001-1439
US

IV. Provider business mailing address

210 NW BARSTOW ST STE 201
WAUKESHA WI
53188-3771
US

V. Phone/Fax

Practice location:
  • Phone: 715-268-8000
  • Fax:
Mailing address:
  • Phone: 612-618-3659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number76273
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: