Healthcare Provider Details

I. General information

NPI: 1871739995
Provider Name (Legal Business Name): MICHELLE KRISTIE BEAHM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE KRISTIE KONKEL RN

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 N PORT WASHINGTON RD STE 200
GLENDALE WI
53217-4927
US

IV. Provider business mailing address

5555 N PORT WASHINGTON RD STE 200
GLENDALE WI
53217-4927
US

V. Phone/Fax

Practice location:
  • Phone: 262-999-3495
  • Fax:
Mailing address:
  • Phone: 262-999-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number161780-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15751
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number15751-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: