Healthcare Provider Details

I. General information

NPI: 1932464468
Provider Name (Legal Business Name): ANNALYSE VICTORIA VICTOR MSN, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNALYSE VICTORIA KREGER

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N16W24131 RIVERWOOD DR CANCER CENTER
WAUKESHA WI
53188-1106
US

IV. Provider business mailing address

W369S10410 SHEARER RD
EAGLE WI
53119-1719
US

V. Phone/Fax

Practice location:
  • Phone: 262-930-0005
  • Fax:
Mailing address:
  • Phone: 262-930-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number17809930
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6452
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number6452-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: