Healthcare Provider Details

I. General information

NPI: 1235800996
Provider Name (Legal Business Name): NESSREEN KASHEF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11558 N PORT WASHINGTON RD
MEQUON WI
53092-3416
US

IV. Provider business mailing address

10853 N SAN MARINO DR
MEQUON WI
53092-5847
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-7983
  • Fax: 262-241-8231
Mailing address:
  • Phone: 414-378-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number19487-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: