Healthcare Provider Details

I. General information

NPI: 1487980975
Provider Name (Legal Business Name): SUSAN K. GRESSER MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax: 414-389-4252
Mailing address:
  • Phone: 414-384-2000
  • Fax: 414-389-4252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number110745-030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number2603-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: