Healthcare Provider Details

I. General information

NPI: 1972664340
Provider Name (Legal Business Name): RISA A ANDERSON APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

9875 S FRANKLIN DR
FRANKLIN WI
53132-8895
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-1292
  • Fax: 414-385-8721
Mailing address:
  • Phone: 414-649-1292
  • Fax: 414-858-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1517
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number125006-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: