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General NPI Number Information
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NPI Number | 1598098188
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Entity Type | Individual
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Provider Name | NICOLE CRIVELLO APNP
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Gender | Female
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 725 AMERICAN AVE
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City | WAUKESHA
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State | WI
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Zip | 53188-5031
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Country | US
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Telephone | 262-928-1000
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Fax |
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Provider Business Mailing Address
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Address Line | N8064 KADAD LN
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City | EAST TROY
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State | WI
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Zip | 53120-1863
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Country | US
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Telephone | 414-587-8705
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 165439-030
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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 | 10297-33
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License Number State | WI
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