Healthcare Provider Details

I. General information

NPI: 1104927227
Provider Name (Legal Business Name): BARBARA J PAVLOVICH APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8923 W BROWN DEER RD
MILWAUKEE WI
53224-2120
US

IV. Provider business mailing address

5500 BROWN DEER ROAD SUITE 100
MILWAUKEE WI
53223
US

V. Phone/Fax

Practice location:
  • Phone: 414-355-4300
  • Fax: 414-355-4608
Mailing address:
  • Phone: 414-355-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number801-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: