Healthcare Provider Details

I. General information

NPI: 1912347170
Provider Name (Legal Business Name): KASI SAVAGE MAYHALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 N MAYFAIR RD MCW PAIN MANAGEMENT CENTER
MILWAUKEE WI
53226-3465
US

IV. Provider business mailing address

959 N MAYFAIR RD MCW PAIN MANAGEMENT CENTER
MILWAUKEE WI
53226-3465
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-7601
  • Fax: 414-955-6020
Mailing address:
  • Phone: 414-955-7601
  • Fax: 414-955-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221761
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6412
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07415
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: