=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245114792
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN REBECCA RAFALOW NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2025
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9814D W FOREST HOME AVE
-----------------------------------------------------
City | HALES CORNERS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53130-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-499-2870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9814D W FOREST HOME AVE
-----------------------------------------------------
City | HALES CORNERS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53130-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-499-2870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 16974-33
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------