MEDICARE: SUE XIONG APNP

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	363LF0000X	Family Nurse Practitioner	9067-33	WI
2	363L00000X	Nurse Practitioner	9067	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609430396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE XIONG APNP

Provider Business Mailing Address
First Line	:	3301 W FOREST HOME AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2843
Country	:	US
Telephone Number	:	920-434-3880
Fax Number	:	920-434-3882

Provider Business Practice Location Address
First Line	:	464 CARDINAL LN
Second Line	:
City	:	HOWARD
State	:	WI
Zip	:	54313-9569
Country	:	US
Telephone Number	:	920-434-3880
Fax Number	:	920-434-3882

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

Provider Enumeration Date	:	04/28/2019
Last Update Date	:	11/24/2021

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