Healthcare Provider Details

I. General information

NPI: 1457640948
Provider Name (Legal Business Name): ANGELA MARIE PELZEK APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA MARIE FELLIN APNP

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 N RIVER CENTER DR STE 206
MILWAUKEE WI
53212-3958
US

IV. Provider business mailing address

1555 N RIVER CENTER DR STE 206
MILWAUKEE WI
53212-3958
US

V. Phone/Fax

Practice location:
  • Phone: 414-272-5607
  • Fax: 414-272-5617
Mailing address:
  • Phone: 414-272-5607
  • Fax: 414-272-5617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4326-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: