Healthcare Provider Details

I. General information

NPI: 1821467986
Provider Name (Legal Business Name): JILLIAN MARIE O'GRADY APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 RIVERVIEW AVE
WAUKESHA WI
53188-3631
US

IV. Provider business mailing address

514 RIVERVIEW AVE
WAUKESHA WI
53188-3631
US

V. Phone/Fax

Practice location:
  • Phone: 262-548-7666
  • Fax: 262-970-6696
Mailing address:
  • Phone: 262-548-7666
  • Fax: 262-970-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6651-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6651-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: