Healthcare Provider Details

I. General information

NPI: 1093711236
Provider Name (Legal Business Name): DANA M. FIELDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA M D'ERCOLE

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W129N7055 NORTHFIELD DR
MENOMONEE FALLS WI
53051-0538
US

IV. Provider business mailing address

W129N7055 NORTHFIELD DR
MENOMONEE FALLS WI
53051-0538
US

V. Phone/Fax

Practice location:
  • Phone: 262-253-5400
  • Fax:
Mailing address:
  • Phone: 262-253-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1256-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: