Healthcare Provider Details

I. General information

NPI: 1083523518
Provider Name (Legal Business Name): MICHAEL RODRIQUES MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 N 48TH ST
MILWAUKEE WI
53208-1124
US

IV. Provider business mailing address

2203 N 48TH ST
MILWAUKEE WI
53208-1124
US

V. Phone/Fax

Practice location:
  • Phone: 414-530-8896
  • Fax:
Mailing address:
  • Phone: 414-530-8896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number19002-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: