Healthcare Provider Details

I. General information

NPI: 1952210486
Provider Name (Legal Business Name): BONNIE ECKL APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 W RIVER WOODS PKWY
GLENDALE WI
53212-1081
US

IV. Provider business mailing address

2572 N 65TH ST
WAUWATOSA WI
53213-1409
US

V. Phone/Fax

Practice location:
  • Phone: 414-961-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1894733
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: