Healthcare Provider Details

I. General information

NPI: 1437071982
Provider Name (Legal Business Name): EQUICARE 360 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 N 33RD ST
MILWAUKEE WI
53208-1904
US

IV. Provider business mailing address

1710 N 33RD ST
MILWAUKEE WI
53208-1904
US

V. Phone/Fax

Practice location:
  • Phone: 414-930-8333
  • Fax:
Mailing address:
  • Phone: 414-930-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REBECCA RUSS
Title or Position: OWNER
Credential: APNP
Phone: 414-930-8333