Healthcare Provider Details

I. General information

NPI: 1043768724
Provider Name (Legal Business Name): ALYSSA SEKADLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E WASHINGTON ST
WEST BEND WI
53095-2571
US

IV. Provider business mailing address

949 N 9TH ST
MILWAUKEE WI
53233-1422
US

V. Phone/Fax

Practice location:
  • Phone: 262-338-2717
  • Fax: 262-338-9767
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7239-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7239
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: