Healthcare Provider Details

I. General information

NPI: 1902967714
Provider Name (Legal Business Name): SARAH KATE WHEELER GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SARAH KATE PARKER

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-0505
  • Fax: 414-805-4606
Mailing address:
  • Phone: 414-805-0505
  • Fax: 414-805-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2989
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: