Healthcare Provider Details

I. General information

NPI: 1891437703
Provider Name (Legal Business Name): PAIGE KOKTA APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE LYNAM APNP

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-3690
  • Fax: 414-266-3676
Mailing address:
  • Phone: 414-266-3690
  • Fax: 414-266-3676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number13369
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: