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General NPI Number Information
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NPI Number | 1043473242
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Entity Type | Individual
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Provider Name | TERESA A. JEROFKE NP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 05/23/2011
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Provider Practice Location Address
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Address Line | 9200 W WISCONSIN AVE DIVISION OF SURGICAL ONCOLOGY
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone | 414-805-5701
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Fax | 414-259-9225
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Provider Business Mailing Address
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Address Line | 10000 W INNOVATION DR SUITE 300
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City | MILWAUKEE
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State | WI
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Zip | 53226-4837
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Country | US
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Telephone | 414-456-5006
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Fax | 414-456-6259
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 149532-030
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 149532
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License Number State | WI
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