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General NPI Number Information
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NPI Number | 1518441898
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Entity Type | Individual
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Provider Name | MARIE THERESE USTRUCK FNP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 16650 W BLUEMOUND RD
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City | BROOKFIELD
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State | WI
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Zip | 53005-5920
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Country | US
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Telephone | 414-777-3754
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Fax |
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Provider Business Mailing Address
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Address Line | 8706 SADLER DR
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City | WATERFORD
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State | WI
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Zip | 53185-1506
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Country | US
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Telephone | 262-939-1883
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 8348-33
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License Number State | WI
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