Healthcare Provider Details

I. General information

NPI: 1902716608
Provider Name (Legal Business Name): NICOLE DREW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2816 W CLARKE ST
MILWAUKEE WI
53210-2621
US

IV. Provider business mailing address

2544 N FREDERICK AVE
MILWAUKEE WI
53211-4063
US

V. Phone/Fax

Practice location:
  • Phone: 414-267-1030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: