MEDICARE: TRISHA COMMODORE RN

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	163WS0200X	School Registered Nurse	151021-30	WI

General Provider Information

NPI Number	:	1154259877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISHA COMMODORE RN

Provider Business Mailing Address
First Line	:	3433 S COLONY AVE
Second Line	:
City	:	UNION GROVE
State	:	WI
Zip	:	53182-9673
Country	:	US
Telephone Number	:	262-878-2893
Fax Number	:	262-878-4056

Provider Business Practice Location Address
First Line	:	3433 S COLONY AVE
Second Line	:
City	:	UNION GROVE
State	:	WI
Zip	:	53182-9673
Country	:	US
Telephone Number	:	262-878-2893
Fax Number	:	262-878-4056

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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