Healthcare Provider Details

I. General information

NPI: 1962756460
Provider Name (Legal Business Name): MONICA CLARE RYAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA CLARE KERSCHNER PA-C

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 PLEASANT VALLEY RD DEPARTMENT OF UROLOGY, UROLOGIC ONCOLOGY DIVISION
WEST BEND WI
53095
US

IV. Provider business mailing address

8701 WATERTOWN PLANK ROAD DEPARTMENT OF UROLOGY
MILWAUKEE WI
53226-3548
US

V. Phone/Fax

Practice location:
  • Phone: 262-836-7200
  • Fax:
Mailing address:
  • Phone: 414-955-0856
  • Fax: 414-955-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number23016189
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3409
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: