Healthcare Provider Details

I. General information

NPI: 1073385357
Provider Name (Legal Business Name): CARA ROSELLA SMARJESSE WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 N BROADWAY
MILWAUKEE WI
53202-3614
US

IV. Provider business mailing address

11011 W NORTH AVE APT 422
WAUWATOSA WI
53226-2273
US

V. Phone/Fax

Practice location:
  • Phone: 262-518-7448
  • Fax:
Mailing address:
  • Phone: 309-635-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number041463253
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1102204
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: