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General NPI Number Information
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NPI Number | 1457459869
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Entity Type | Individual
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Provider Name | NICHOLE VIRGO APNP
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 8901 N 76TH ST FL 3
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City | MILWAUKEE
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State | WI
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Zip | 53223-1901
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Country | US
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Telephone | 414-357-1307
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Fax | 414-365-0773
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Provider Business Mailing Address
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Address Line | 1225 W PINE CREEK CT
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City | OAK CREEK
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State | WI
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Zip | 53154-1833
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Country | US
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Telephone | 414-745-5158
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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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 148802
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3323-33
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 139386-30
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3323
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License Number State | WI
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