Healthcare Provider Details

I. General information

NPI: 1578490553
Provider Name (Legal Business Name): JERRI USTBY-CRUZ BYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E BADGER RD
MADISON WI
53713-2120
US

IV. Provider business mailing address

501 E BADGER RD
MADISON WI
53713-2120
US

V. Phone/Fax

Practice location:
  • Phone: 608-204-1061
  • Fax: 608-204-0364
Mailing address:
  • Phone: 608-204-1061
  • Fax: 608-204-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number93473-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: