Healthcare Provider Details

I. General information

NPI: 1851849277
Provider Name (Legal Business Name): RACHEL K CONLIN APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL K GROAT APNP

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

2901 W KINNICKINNIC RIVER PKWY
MILWAUKEE WI
53215-3677
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6000
  • Fax:
Mailing address:
  • Phone: 414-649-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number197948
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7208-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: