Healthcare Provider Details

I. General information

NPI: 1164864997
Provider Name (Legal Business Name): ANGELA M RYAN JOLIVETTE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA M RYAN NP

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE DEPARTMENT OF NEUROSURGERY
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE DEPARTMENT OF NEUROSURGERY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-5400
  • Fax: 414-955-0115
Mailing address:
  • Phone: 414-805-5400
  • Fax: 414-955-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number174144
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: