Healthcare Provider Details

I. General information

NPI: 1407809072
Provider Name (Legal Business Name): BRONWYN L DILLEY APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRONWYN L KRUGER NP

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 GREENWAY BLVD STE 160
MIDDLETON WI
53562-3689
US

IV. Provider business mailing address

8215 GREENWAY BLVD STE 160
MIDDLETON WI
53562-3689
US

V. Phone/Fax

Practice location:
  • Phone: 262-999-3495
  • Fax:
Mailing address:
  • Phone: 262-789-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1617-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: