Healthcare Provider Details

I. General information

NPI: 1982608899
Provider Name (Legal Business Name): JOAN M. ANDERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W180N8085 TOWN HALL RD
MENOMONEE FALLS WI
53051-3518
US

IV. Provider business mailing address

W339S4971 FOX HOLLOW DR
DOUSMAN WI
53118-9742
US

V. Phone/Fax

Practice location:
  • Phone: 262-257-5000
  • Fax: 262-257-5005
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number58271-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: