Healthcare Provider Details

I. General information

NPI: 1780139022
Provider Name (Legal Business Name): SAMANTHA MARIE WOJNOWIAK APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 06/05/2021
Certification Date: 06/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-3417
  • Fax: 414-805-2934
Mailing address:
  • Phone: 414-805-3417
  • Fax: 414-805-2934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number7145
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: