Healthcare Provider Details

I. General information

NPI: 1083012025
Provider Name (Legal Business Name): JULIE DRISCOLL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 W NORTH AVE
MILWAUKEE WI
53213-1527
US

IV. Provider business mailing address

8730 S CHICAGO RD
OAK CREEK WI
53154-4212
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-6315
  • Fax: 414-771-6311
Mailing address:
  • Phone: 414-828-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5960-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: