Healthcare Provider Details

I. General information

NPI: 1992123830
Provider Name (Legal Business Name): VANESSA MCFADDEN MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 07/21/2022
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVENUE DEPT OF PEDIATRICS
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVENUE DEPT OF PEDIATRICS
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-607-5280
  • Fax:
Mailing address:
  • Phone: 414-607-5280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64541
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number64541
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: