Healthcare Provider Details

I. General information

NPI: 1619087145
Provider Name (Legal Business Name): LINDA M WESP N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/03/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 N PORT WASHINGTON RD STE 325
GLENDALE WI
53212-1000
US

IV. Provider business mailing address

4655 N PORT WASHINGTON RD STE 325
GLENDALE WI
53212-1000
US

V. Phone/Fax

Practice location:
  • Phone: 414-269-8282
  • Fax: 414-269-8280
Mailing address:
  • Phone: 414-999-1099
  • Fax: 414-999-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6596-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337230
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: