Healthcare Provider Details

I. General information

NPI: 1952272767
Provider Name (Legal Business Name): TAYLOR WIESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 N BILTMORE LN
MADISON WI
53718-2161
US

IV. Provider business mailing address

2929 N MAYFAIR RD UNIT 328
WAUWATOSA WI
53222-4325
US

V. Phone/Fax

Practice location:
  • Phone: 608-592-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number237132-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: