Healthcare Provider Details

I. General information

NPI: 1447732110
Provider Name (Legal Business Name): EMMA PETTY DNP, RN, FNP-BC, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11333 W NATIONAL AVE
MILWAUKEE WI
53227-3111
US

IV. Provider business mailing address

2808 W JUNEAU AVE
MILWAUKEE WI
53208
US

V. Phone/Fax

Practice location:
  • Phone: 414-329-4979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8842
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8842-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number195659-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: