Healthcare Provider Details

I. General information

NPI: 1588725436
Provider Name (Legal Business Name): JODI LEIGH DREIER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 W LAYTON AVE
MILWAUKEE WI
53220-3849
US

IV. Provider business mailing address

7330 W LAYTON AVE
MILWAUKEE WI
53220-3849
US

V. Phone/Fax

Practice location:
  • Phone: 414-817-8896
  • Fax: 414-817-8940
Mailing address:
  • Phone: 414-817-8896
  • Fax: 414-817-8940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1534-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: