Healthcare Provider Details

I. General information

NPI: 1356259543
Provider Name (Legal Business Name): DJ PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 S 1ST ST APT 313
MILWAUKEE WI
53207-1116
US

IV. Provider business mailing address

2033 S 1ST ST APT 313
MILWAUKEE WI
53207-1116
US

V. Phone/Fax

Practice location:
  • Phone: 262-661-9627
  • Fax:
Mailing address:
  • Phone: 414-212-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DOMINIC JAMES
Title or Position: OWNER
Credential: APRN
Phone: 414-212-5228