Healthcare Provider Details

I. General information

NPI: 1457179301
Provider Name (Legal Business Name): JAYME BETH SERVIA DNP, PMHNP, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 W CAPITOL DR
MILWAUKEE WI
53222-1338
US

IV. Provider business mailing address

2805 N PIERCE ST
MILWAUKEE WI
53212-2548
US

V. Phone/Fax

Practice location:
  • Phone: 414-810-4844
  • Fax:
Mailing address:
  • Phone: 920-381-4491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number15966-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: