Healthcare Provider Details

I. General information

NPI: 1750540803
Provider Name (Legal Business Name): KATHLEEN S. CANTIERI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W NATIONAL AVE SUITE 400
MILWAUKEE WI
53204-1714
US

IV. Provider business mailing address

13500 WRAYBURN RD
ELM GROVE WI
53122-1350
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-1400
  • Fax:
Mailing address:
  • Phone: 262-786-9350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number78890-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: