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General NPI Number Information
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NPI Number | 1154322147
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Entity Type | Individual
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Provider Name | NISHA DESHPANDE PA
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Gender | Female
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 3400 MARKET LN STE 300
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City | KENOSHA
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State | WI
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Zip | 53144-3430
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Country | US
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Telephone | 262-551-4600
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Fax | 262-551-4630
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Provider Business Mailing Address
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Address Line | 6308 8TH AVE STE 105
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City | KENOSHA
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State | WI
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Zip | 53143-5031
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Country | US
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Telephone | 262-577-8522
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8366-23
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License Number State | WI
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