Healthcare Provider Details

I. General information

NPI: 1700707221
Provider Name (Legal Business Name): JOSHUA ZASTROW PMHNP
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 S 92ND ST APT 2
WEST ALLIS WI
53227-2353
US

IV. Provider business mailing address

2330 S 92ND ST APT 2
WEST ALLIS WI
53227-2353
US

V. Phone/Fax

Practice location:
  • Phone: 262-719-8698
  • Fax:
Mailing address:
  • Phone: 262-719-8698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18692-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: