Healthcare Provider Details

I. General information

NPI: 1326169046
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF WI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N JACKSON ST
MILWAUKEE WI
53202-5904
US

IV. Provider business mailing address

302 N JACKSON ST
MILWAUKEE WI
53202-5904
US

V. Phone/Fax

Practice location:
  • Phone: 414-289-3701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MARIE ODEGAARD
Title or Position: DIRECTOR, BUSINESS OPERATIONS
Credential:
Phone: 414-289-3796