Healthcare Provider Details

I. General information

NPI: 1720677925
Provider Name (Legal Business Name): MANSI PATEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 N GRANDVIEW BLVD
WAUKESHA WI
53188-6906
US

IV. Provider business mailing address

N97W15790 BURR OAK RD
GERMANTOWN WI
53022-5121
US

V. Phone/Fax

Practice location:
  • Phone: 262-875-5070
  • Fax:
Mailing address:
  • Phone: 630-965-1769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08200322
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: