Healthcare Provider Details

I. General information

NPI: 1174099063
Provider Name (Legal Business Name): LOURDES T ROBLES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W BRUCE ST STE 200
MILWAUKEE WI
53204-1667
US

IV. Provider business mailing address

130 W BRUCE ST STE 200
MILWAUKEE WI
53204-1667
US

V. Phone/Fax

Practice location:
  • Phone: 414-672-7012
  • Fax:
Mailing address:
  • Phone: 414-672-7012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07180368
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8884-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: