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General NPI Number Information
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NPI Number | 1073487641
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Entity Type | Organization
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Legal Business Name | NUESTRA ESPERANZA HEALTH LLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 1282 E HICKORY CREEK CT
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City | OAK CREEK
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State | WI
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Zip | 53154-7316
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Country | US
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Telephone | 414-690-0069
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Fax |
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Provider Business Mailing Address
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Address Line | 790 N MILWAUKEE ST STE 302
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City | MILWAUKEE
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State | WI
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Zip | 53202-4073
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Country | US
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Telephone | 414-690-0069
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Fax | 318-225-8165
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | CODIE JORDAN VASSAR
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Credential | MD
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Telephone | 414-690-0069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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