Healthcare Provider Details

I. General information

NPI: 1801110184
Provider Name (Legal Business Name): ANNE MEREDITH LAROSA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE DIVISION OF NEPHROLOGY
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE DIVISION OF NEPHROLOGY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-3100
  • Fax: 414-259-1145
Mailing address:
  • Phone: 414-805-3100
  • Fax: 414-259-1145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number152765
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: