Healthcare Provider Details

I. General information

NPI: 1639645740
Provider Name (Legal Business Name): TAYLOR CATHERINE VILLWOCK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 N RIVERCENTER DR
MILWAUKEE WI
53212-3978
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-283-8444
  • Fax: 414-274-5021
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8771
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number8771-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: