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General NPI Number Information
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NPI Number | 1669391207
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Entity Type | Individual
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Provider Name | PA HOUA CHOUA THAO
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Gender | Female
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 7704 TERRACE AVE STE 1
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City | MIDDLETON
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State | WI
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Zip | 53562-3122
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Country | US
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Telephone | 715-725-0242
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Fax |
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Provider Business Mailing Address
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Address Line | 4139 ETON CIR
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City | WINDSOR
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State | WI
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Zip | 53598-9135
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Country | US
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Telephone |
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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 | 18704-33
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License Number State | WI
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