Healthcare Provider Details

I. General information

NPI: 1720236789
Provider Name (Legal Business Name): BRENDA SUE NOLEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W VILLARD AVE ALL SAINTS FAMILY CARE CENTER
MILWAUKEE WI
53209-4901
US

IV. Provider business mailing address

2400 W VILLARD AVE ALL SAINTS FAMILY CARE CENTER
MILWAUKEE WI
53209-4901
US

V. Phone/Fax

Practice location:
  • Phone: 414-527-8348
  • Fax: 414-527-8046
Mailing address:
  • Phone: 414-527-8348
  • Fax: 414-527-8046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number141178
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: