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General NPI Number Information
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NPI Number | 1528735560
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Entity Type | Individual
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Provider Name | MISCHA RENEE CORDLE APNP
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Gender | Female
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 215 CORPORATE DR STE D
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City | BEAVER DAM
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State | WI
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Zip | 53916-3124
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Country | US
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Telephone | 920-356-9415
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Fax | 920-356-9477
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Provider Business Mailing Address
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Address Line | 215 CORPORATE DR STE D
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City | BEAVER DAM
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State | WI
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Zip | 53916-3124
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Country | US
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Telephone | 203-569-4159
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Fax | 920-356-9477
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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 | 11254-33
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License Number State | WI
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