Healthcare Provider Details

I. General information

NPI: 1245162254
Provider Name (Legal Business Name): SERRA C SUDEMIR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 W LLOYD ST
MILWAUKEE WI
53205-1243
US

IV. Provider business mailing address

6220 N SUNNY POINT RD
GLENDALE WI
53217-4170
US

V. Phone/Fax

Practice location:
  • Phone: 414-264-6000
  • Fax:
Mailing address:
  • Phone: 414-378-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number185376-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: