Healthcare Provider Details

I. General information

NPI: 1356731558
Provider Name (Legal Business Name): NOOR BACHHUBER BONTZ ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESE ELIZABETH BACHHUBER RN

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-434-1000
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number220675
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15511-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number15511
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: