Healthcare Provider Details

I. General information

NPI: 1972904522
Provider Name (Legal Business Name): STEPHANIE BRESLOW APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W MORELAND BLVD
WAUKESHA WI
53188-2462
US

IV. Provider business mailing address

615 W MORELAND BLVD
WAUKESHA WI
53188-2462
US

V. Phone/Fax

Practice location:
  • Phone: 262-896-8420
  • Fax: 262-896-8521
Mailing address:
  • Phone: 262-896-8420
  • Fax: 262-896-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6009-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: