=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649189721
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE N. CASTILLO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2026
-----------------------------------------------------
Last Update Date | 09/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5143 S 21ST ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53221-3533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-304-6327
-----------------------------------------------------
Fax | 414-304-6315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5225 W VLIET ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53208-2698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-304-6327
-----------------------------------------------------
Fax | 414-304-6315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 33540-31
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------