Healthcare Provider Details

I. General information

NPI: 1801842125
Provider Name (Legal Business Name): SUSAN L.R. NASIF APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N MAYFAIR RD
WAUWATOSA WI
53226-3436
US

IV. Provider business mailing address

2025 E NEWPORT AVE
MILWAUKEE WI
53211-2906
US

V. Phone/Fax

Practice location:
  • Phone: 414-479-8695
  • Fax: 414-476-8440
Mailing address:
  • Phone: 414-906-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2790
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: