Healthcare Provider Details

I. General information

NPI: 1295625564
Provider Name (Legal Business Name): MIRANDA L WEINKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRANDA GILLITZER

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 DEMING WAY
MIDDLETON WI
53562-5527
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-890-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number17020-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: