=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205117827
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDI LEIGH PHILIP A.N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2011
-----------------------------------------------------
Last Update Date | 12/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1325 S PARKWAY DR 5000 W. NATIONAL AVENUE
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53005-7356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-789-5049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1325 S PARKWAY DR
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53005-7356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-789-5049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 4549-33
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------