Healthcare Provider Details

I. General information

NPI: 1891614764
Provider Name (Legal Business Name): POLLY FRISQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

E1640 COUNTY RD S
LUXEMBURG WI
54217-8838
US

V. Phone/Fax

Practice location:
  • Phone: 920-431-2457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number26265630
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: