Healthcare Provider Details

I. General information

NPI: 1063848364
Provider Name (Legal Business Name): TIMOTHY E WIRSCHING APNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 W BURLEIGH ST
MILWAUKEE WI
53210-1662
US

IV. Provider business mailing address

5015 W BURLEIGH ST
MILWAUKEE WI
53210-1662
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-2221
  • Fax: 414-874-4507
Mailing address:
  • Phone: 414-447-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5474
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: