Healthcare Provider Details

I. General information

NPI: 1154876175
Provider Name (Legal Business Name): KATHERINE A FAUST FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 S 20TH ST STE 100
MILWAUKEE WI
53215-4940
US

IV. Provider business mailing address

3305 S 20TH ST STE 100
MILWAUKEE WI
53215-4940
US

V. Phone/Fax

Practice location:
  • Phone: 414-645-1984
  • Fax:
Mailing address:
  • Phone: 414-645-1984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7169-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: