=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124578810
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEELAM PATEL NAIR FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2016
-----------------------------------------------------
Last Update Date | 07/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 614 MEMORIAL DR
-----------------------------------------------------
City | CHILTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53014-1568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-849-7555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 257 W SAINT GEORGE AVE
-----------------------------------------------------
City | GRANTSBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54840-7827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-463-5353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 7673-33
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 7673-33
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP132164
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------