Healthcare Provider Details

I. General information

NPI: 1326783630
Provider Name (Legal Business Name): ANDREA JEAN LANGLEY CARLSON APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-3100
  • Fax: 262-532-9584
Mailing address:
  • Phone: 414-805-3100
  • Fax: 262-532-9584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number230969
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number13063
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: