Healthcare Provider Details

I. General information

NPI: 1023808672
Provider Name (Legal Business Name): PERRY HENNESSY APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11414 W PARK PL STE 202
MILWAUKEE WI
53224-3500
US

IV. Provider business mailing address

5204 MESKER ST
WESTON WI
54476-3019
US

V. Phone/Fax

Practice location:
  • Phone: 877-906-9699
  • Fax:
Mailing address:
  • Phone: 715-966-5046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number16782-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: