MEDICARE: BROADWAY PSYCHIATRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1033052212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADWAY PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	S23W23187 E BROADWAY
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53186
Country	:	US
Telephone Number	:	262-588-6774
Fax Number	:	414-296-8740

Provider Business Practice Location Address
First Line	:	S23W23187 E BROADWAY
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53186
Country	:	US
Telephone Number	:	262-588-6774
Fax Number	:	414-296-8740

Authorized Official
Title or Position	:	ADVANCED PRACTICE NURSE PRESCRIBER
Name	:	WENDY WARD
Credential	:	MSN, APNP, PMHNP-BC
Telephone Number	:	262-588-6774

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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