Healthcare Provider Details

I. General information

NPI: 1881056471
Provider Name (Legal Business Name): TERAYA RENAI FRANKLIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9697 SAINT CATHERINES DR STE 300
PLEASANT PRAIRIE WI
53158-2118
US

IV. Provider business mailing address

6308 8TH AVE
KENOSHA WI
53143-5031
US

V. Phone/Fax

Practice location:
  • Phone: 262-577-8320
  • Fax: 262-577-8321
Mailing address:
  • Phone: 262-656-3313
  • Fax: 262-653-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6903-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: