Healthcare Provider Details

I. General information

NPI: 1053727362
Provider Name (Legal Business Name): DAWN O'SHEA-FARLEY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 10/15/2014
Certification Date: O'SHEA-FARLEY DAWN 7977 W FIEBRANTZ AVE MILWAUKEE WI 53222 7977 W FIEBRANTZ AVE MILWAUKEE WI 53222
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7977 W FIEBRANTZ AVE
MILWAUKEE WI
53222-1952
US

IV. Provider business mailing address

7977 W FIEBRANTZ AVE
MILWAUKEE WI
53222-1952
US

V. Phone/Fax

Practice location:
  • Phone: 414-438-0844
  • Fax: 414-438-0844
Mailing address:
  • Phone: 414-438-0844
  • Fax: 414-438-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: