Healthcare Provider Details

I. General information

NPI: 1386576601
Provider Name (Legal Business Name): REBECCA HARDGROVE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 W GRANT ST
WEST ALLIS WI
53227-1310
US

IV. Provider business mailing address

10230 W GRANT ST
WEST ALLIS WI
53227-1310
US

V. Phone/Fax

Practice location:
  • Phone: 414-604-4000
  • Fax:
Mailing address:
  • Phone: 414-604-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number136121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: