Healthcare Provider Details

I. General information

NPI: 1134925597
Provider Name (Legal Business Name): SAFIA KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 W LAYTON AVE
MILWAUKEE WI
53221-2426
US

IV. Provider business mailing address

803 W LAYTON AVE
MILWAUKEE WI
53221-2426
US

V. Phone/Fax

Practice location:
  • Phone: 414-939-4411
  • Fax:
Mailing address:
  • Phone: 414-939-4411
  • Fax: 414-939-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16532-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: