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General NPI Number Information
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NPI Number | 1316612245
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Entity Type | Individual
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Provider Name | THERESA ANN NAMETH
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Gender | Female
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 19475 W NORTH AVE STE 305
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City | BROOKFIELD
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State | WI
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Zip | 53045-4199
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Country | US
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Telephone | 262-785-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 2427 14TH AVE
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City | SOUTH MILWAUKEE
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State | WI
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Zip | 53172-2403
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Country | US
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Telephone | 414-218-4751
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11128-33
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License Number State | WI
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