Healthcare Provider Details

I. General information

NPI: 1083094759
Provider Name (Legal Business Name): KATHRYN EGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 N MAYFAIR RD
MILWAUKEE WI
53226
US

IV. Provider business mailing address

959 N MAYFAIR RD
MILWAUKEE WI
53226-3465
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-7601
  • Fax: 414-955-6020
Mailing address:
  • Phone: 414-955-7601
  • Fax: 414-955-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN.0991790-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number8436
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: